MEDICARE: CHICAGO HEAD AND NECK SURGICAL SPECIALISTS SC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207YS0123X	Facial Plastic Surgery Physician
2	207Y00000X	Otolaryngology Physician	IL
3	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician
4	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1932108396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO HEAD AND NECK SURGICAL SPECIALISTS SC

Provider Business Mailing Address
First Line	:	PO BOX 64568
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-4568
Country	:	US
Telephone Number	:	477-819-3688
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 BARRINGTON RD
Second Line	:	SUITE #305
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60194-1057
Country	:	US
Telephone Number	:	847-843-2000
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	AJAY K. CHAUHAN
Credential	:	D.O.
Telephone Number	:	847-843-2000

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/21/2022

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