Provider Demographics
NPI:1881906535
Name:ALAN CHEN SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:ALAN CHEN SURGICAL ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:815-729-9527
Mailing Address - Street 1:823 N 129TH INFANTRY DR
Mailing Address - Street 2:STE 103
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8346
Mailing Address - Country:US
Mailing Address - Phone:815-729-9527
Mailing Address - Fax:815-729-9530
Practice Address - Street 1:823 N 129TH INFANTRY DR
Practice Address - Street 2:STE 103
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8346
Practice Address - Country:US
Practice Address - Phone:815-729-9527
Practice Address - Fax:815-729-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361173072082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1689878480Medicaid