Healthcare Provider Details

I. General information

NPI: 1740361898
Provider Name (Legal Business Name): CHUN TONG CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11416 S MICHIGAN AVE
CHICAGO IL
60628-4932
US

IV. Provider business mailing address

9680 GOLF RD
DES PLAINES IL
60016-1522
US

V. Phone/Fax

Practice location:
  • Phone: 773-821-1414
  • Fax: 773-821-1817
Mailing address:
  • Phone: 847-699-0800
  • Fax: 847-296-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036046857
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: