Provider Demographics
NPI:1700055571
Name:METROPOLITAN CHICAGO HEALTH ASSOCIATION
Entity Type:Organization
Organization Name:METROPOLITAN CHICAGO HEALTH ASSOCIATION
Other - Org Name:MCHA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-995-3405
Mailing Address - Street 1:45 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4247
Mailing Address - Country:US
Mailing Address - Phone:773-995-3110
Mailing Address - Fax:773-995-1076
Practice Address - Street 1:45 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4247
Practice Address - Country:US
Practice Address - Phone:773-995-3110
Practice Address - Fax:773-995-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty