MEDICARE: MR. VUTHIK T. CHHAY PA-C

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	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1558484196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VUTHIK T. CHHAY PA-C

Provider Business Mailing Address
First Line	:	5316 N LEAVITT ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1113
Country	:	US
Telephone Number	:	773-561-3727
Fax Number	:	773-826-9601

Provider Business Practice Location Address
First Line	:	4800 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3223
Country	:	US
Telephone Number	:	773-826-9600
Fax Number	:	773-826-9601

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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