Provider Demographics
NPI:1770847766
Name:CHAN, EUNICE (DO)
Entity Type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LAKE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1147
Mailing Address - Country:US
Mailing Address - Phone:708-524-8600
Mailing Address - Fax:708-524-8147
Practice Address - Street 1:1010 LAKE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1147
Practice Address - Country:US
Practice Address - Phone:708-524-8600
Practice Address - Fax:708-524-8147
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-137660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036137660Medicaid
IL036137660Medicaid