Provider Demographics
NPI:1508067471
Name:CHICAGO HEIGHTS MEDICAL CONSULTANTS S.C.
Entity Type:Organization
Organization Name:CHICAGO HEIGHTS MEDICAL CONSULTANTS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BAMPEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-756-1000
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0975
Mailing Address - Country:US
Mailing Address - Phone:708-756-1000
Mailing Address - Fax:708-756-6748
Practice Address - Street 1:1423 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3400
Practice Address - Country:US
Practice Address - Phone:708-799-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046854207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01616205OtherBLUE SHIELD
IL036046854Medicaid
010025527OtherRAILROAD MEDICARE
IL036046854Medicaid
IL01616205OtherBLUE SHIELD