Provider Demographics
NPI:1437105061
Name:MICHELLE CHABAN, P.C.
Entity Type:Organization
Organization Name:MICHELLE CHABAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:866-220-8371
Mailing Address - Street 1:1640 MARCIE CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3974
Mailing Address - Country:US
Mailing Address - Phone:847-405-0520
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:112
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:866-220-8371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207688Medicare ID - Type Unspecified