Healthcare Provider Details

I. General information

NPI: 1972946812
Provider Name (Legal Business Name): CHAO QI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E CHICAGO AVE DEPARTMENT OF PATHOLOGY
CHICAGO IL
60611-4296
US

IV. Provider business mailing address

303 E CHICAGO AVE DEPARTMENT OF PATHOLOGY
CHICAGO IL
60611-4296
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2181
  • Fax: 312-503-8240
Mailing address:
  • Phone: 312-926-2181
  • Fax: 312-503-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: