Provider Demographics
NPI:1740273507
Name:CHYNA, MARK JAMES (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:CHYNA
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 1:890 GARFIELD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4723
Mailing Address - Country:US
Mailing Address - Phone:847-367-3843
Mailing Address - Fax:
Practice Address - Street 1:890 GARFIELD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-367-3843
Practice Address - Fax:847-367-3063
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG-36784Medicare UPIN