Healthcare Provider Details

I. General information

NPI: 1124445077
Provider Name (Legal Business Name): LU CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1600
CHICAGO IL
60611-2997
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1600
CHICAGO IL
60611-2997
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8106
  • Fax: 312-695-8106
Mailing address:
  • Phone: 312-695-8106
  • Fax: 312-695-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036161311
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2015011944
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: