Provider Demographics
NPI:1407924921
Name:CHIN, MICHAEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CHIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:STE 1919
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2002
Mailing Address - Country:US
Mailing Address - Phone:312-738-3448
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVENUE
Practice Address - Street 2:SUITE 1919
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2002
Practice Address - Country:US
Practice Address - Phone:312-977-1179
Practice Address - Fax:312-977-0425
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005074213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005074Medicaid
IL01633748OtherBCBSIL NUMBER
IL016005074Medicaid
IL207335Medicare ID - Type UnspecifiedGROUP #