Provider Demographics
NPI:1497752893
Name:CHEN, ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
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:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-7406
Mailing Address - Country:US
Mailing Address - Phone:847-568-1870
Mailing Address - Fax:
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:SUITE 808
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-568-1870
Practice Address - Fax:847-568-1875
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-10-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
IL0036-086420173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0937849OtherCLIA ID
IL036086420Medicaid
IL1621458OtherBLUE CROSS/BLUE SHEILD
IL036086420Medicaid
IL14D0937849OtherCLIA ID