Provider Demographics
NPI:1326067075
Name:CHEN, CHAO (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAO
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6259 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2529
Practice Address - Country:US
Practice Address - Phone:773-752-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021603999OtherBCBSIL PROVIDER NUMBER
IL11163OtherAMERIGROUP PROVIDER NUMBE
IL233891OtherHARMONY PROVIDER NUMBER
ILK12653Medicare PIN
IL0021603999OtherBCBSIL PROVIDER NUMBER
IL11163OtherAMERIGROUP PROVIDER NUMBE