Provider Demographics
NPI:1790890598
Name:MARK CHIEN MD LLC
Entity Type:Organization
Organization Name:MARK CHIEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-503-6000
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-503-6000
Mailing Address - Fax:312-503-6329
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 118
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-503-6000
Practice Address - Fax:312-503-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213983Medicare PIN