Provider Demographics
NPI:1922095546
Name:LINCHANGCO, EMMANUEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:C
Last Name:LINCHANGCO
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 1:4201 WINFIELD RD FL 4
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:331-221-2357
Practice Address - Street 1:303 W LAKE ST STE 200
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2500
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215791200OtherWORKERS COMP
4658416OtherAETNA
IL036090399Medicaid
IL2390OtherELMCARE
110132733OtherRR MEDICARE
IL2215351OtherBCBSIL
IL2215351OtherBCBSIL
ILG07138Medicare UPIN