Provider Demographics
NPI:1902831696
Name:CHIANG, PAUL P (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:P
Last Name:CHIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N MAIN ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3112
Mailing Address - Country:US
Mailing Address - Phone:630-614-4960
Mailing Address - Fax:630-682-3727
Practice Address - Street 1:1800 N MAIN ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3112
Practice Address - Country:US
Practice Address - Phone:630-614-4960
Practice Address - Fax:630-682-3727
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091803207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363149833OtherTAX IDENTIFICATION NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL0222075OtherBLUE CROSS GROUP NUMBER
IL0222075OtherBLUE CROSS GROUP NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL363149833OtherTAX IDENTIFICATION NUMBER