Provider Demographics
NPI:1114986049
Name:ELIZABETH K CHUNG, M.D. SC.
Entity Type:Organization
Organization Name:ELIZABETH K CHUNG, M.D. SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-933-1133
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-0809
Mailing Address - Country:US
Mailing Address - Phone:847-933-1133
Mailing Address - Fax:847-933-1122
Practice Address - Street 1:8707 SKOKIE BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2269
Practice Address - Country:US
Practice Address - Phone:847-933-1133
Practice Address - Fax:847-933-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
889383OtherCCN PROVIDER ID
FIRST HEALTH PROVIDEOther889383
IL1635604OtherBC/BS PROVIDER ID
294839OtherAMERIGROUP PROVIDER ID