Healthcare Provider Details

I. General information

NPI: 1013039239
Provider Name (Legal Business Name): ROBERT LENET MD, MAI PHAN MD, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST STE 906
CHICAGO IL
60611-2946
US

IV. Provider business mailing address

150 E HURON ST STE 906
CHICAGO IL
60611-2946
US

V. Phone/Fax

Practice location:
  • Phone: 312-951-0501
  • Fax: 312-951-0970
Mailing address:
  • Phone: 312-951-0501
  • Fax: 312-951-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAI PHAN
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 312-951-0501