Provider Demographics
NPI:1518956101
Name:KHINE, CHO CHO (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHO CHO
Middle Name:
Last Name:KHINE
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 1:1415 CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5257
Mailing Address - Country:US
Mailing Address - Phone:847-915-4426
Mailing Address - Fax:
Practice Address - Street 1:1415 CARLISLE DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60010-5257
Practice Address - Country:US
Practice Address - Phone:847-915-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI24506Medicare UPIN
ILK14764Medicare ID - Type UnspecifiedLOCALITY 99
ILK14763Medicare ID - Type UnspecifiedLOCALITY 16
ILK14327Medicare ID - Type UnspecifiedLOCALITY 15