MEDICARE: DR. CHAO CHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0021603999	OTHER	IL	BCBSIL PROVIDER NUMBER
2	11163	OTHER	IL	AMERIGROUP PROVIDER NUMBE
3	233891	OTHER	IL	HARMONY PROVIDER NUMBER

General Provider Information

NPI Number	:	1326067075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAO CHEN M.D.

Provider Business Mailing Address
First Line	:	2220 ALLEN DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6259 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2529
Country	:	US
Telephone Number	:	773-752-2767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/09/2007

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