Provider Demographics
NPI:1568409720
Name:MCCAMMON-CHASE, NATHALIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:D
Last Name:MCCAMMON-CHASE
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 1:720 LAKE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1424
Mailing Address - Country:US
Mailing Address - Phone:708-358-0791
Mailing Address - Fax:708-948-7523
Practice Address - Street 1:720 LAKE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1424
Practice Address - Country:US
Practice Address - Phone:708-358-0791
Practice Address - Fax:708-948-7523
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619414OtherBCBS GROUP
IL036104978Medicaid
IL3633309286030501Medicaid
IL1619414OtherBCBS GROUP
ILL96783Medicare ID - Type Unspecified
H48087Medicare UPIN
IL739531008 ICCMedicare PIN