Healthcare Provider Details

I. General information

NPI: 1134668064
Provider Name (Legal Business Name): MIN CHO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2017
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S WILKE RD STE 111
ARLINGTON HEIGHTS IL
60005-1524
US

IV. Provider business mailing address

210 S DESPLAINES ST
CHICAGO IL
60661-5500
US

V. Phone/Fax

Practice location:
  • Phone: 847-394-1843
  • Fax:
Mailing address:
  • Phone: 312-654-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.163668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: