Mukesh Chaudhry, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-107111 Issued in IL

Practice address

1175 Cedar CT
Carbondale, IL 62901-5333

Phone

(618) 549-0300

Fax

(618) 549-0600

NPI assigned

Jul 29, 2005

Last updated

Jan 11, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carbondale Family Medicine,LLC

  • Family Medicine Physician
  • Carbondale, IL
  • NPI 1518023530
  Authorized official Same address or phone
• Revive Skin Institute LLC

  dba Dermatology

  • Procedural Dermatology Physician
  • Carbondale, IL
  • NPI 1104178144
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1508866559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 HIGH FOREST DR",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629038245",
            "telephone_number": "618-549-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 CEDAR CT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015333",
            "telephone_number": "618-549-0300",
            "fax_number": "618-549-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAUDHRY",
        "first_name": "MUKESH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-107111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-107111",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chapman Language and Literacy, PLLC
• Hadasah Chapman, MA, CCC-SLP
• Saul Howard Chapman, PH.D.
• Mary Chappell, MA, NCSP
• Anup K Chaudhry, M.D.
• Karla Renee Cheatham Brown, M.D.
• Angela Mei Chen, DDS
• Yuan Chen, M.D.
• Krishna Chaitanya Cherukuri, M.D.
• Alexander Kingston Chevalier, MD

• Family Medicine Physician in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.