Healthcare Provider Details

I. General information

NPI: 1710095823
Provider Name (Legal Business Name): ALBERT N CHAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W PETERSON AVE STE 101
CHICAGO IL
60646-6074
US

IV. Provider business mailing address

4200 W PETERSON AVE STE 101
CHICAGO IL
60646-6052
US

V. Phone/Fax

Practice location:
  • Phone: 773-283-3404
  • Fax: 773-283-3548
Mailing address:
  • Phone: 773-283-3404
  • Fax: 773-283-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: