Provider Demographics
NPI:1457492274
Name:CHOUCAIR, BECHARA (MD)
Entity Type:Individual
Prefix:DR
First Name:BECHARA
Middle Name:
Last Name:CHOUCAIR
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 1:1015 W LAWRENCE AVE
Mailing Address - Street 2:SUITE 438
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5017
Mailing Address - Country:US
Mailing Address - Phone:773-275-2060
Mailing Address - Fax:773-275-3689
Practice Address - Street 1:1015 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5017
Practice Address - Country:US
Practice Address - Phone:773-275-2060
Practice Address - Fax:773-275-3689
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36103425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH33456Medicare UPIN
IL36103425Medicare ID - Type UnspecifiedFAMILY PRACTICE