Provider Demographics
NPI:1659678290
Name:RICHARD C L CHEN MD LTD
Entity Type:Organization
Organization Name:RICHARD C L CHEN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAU
Authorized Official - Middle Name:LIANG
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-345-1112
Mailing Address - Street 1:415 WEST MAIN ST.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234
Mailing Address - Country:US
Mailing Address - Phone:618-345-1112
Mailing Address - Fax:618-345-1113
Practice Address - Street 1:415 WEST MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234
Practice Address - Country:US
Practice Address - Phone:618-345-1112
Practice Address - Fax:618-345-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-53838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053838Medicaid
IL036053838Medicaid
IL2420-41Medicare PIN