Healthcare Provider Details

I. General information

NPI: 1255384707
Provider Name (Legal Business Name): JESSE S CHANDLER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 E 87TH ST
CHICAGO IL
60619-7011
US

IV. Provider business mailing address

1135 E 87TH ST
CHICAGO IL
60619-7011
US

V. Phone/Fax

Practice location:
  • Phone: 773-602-7800
  • Fax:
Mailing address:
  • Phone: 773-602-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JESSE S CHANDLER
Title or Position: CEO
Credential: MD
Phone: 773-602-7800