Healthcare Provider Details

I. General information

NPI: 1740039940
Provider Name (Legal Business Name): CHASE PHILLIPS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 N CALIFORNIA AVE STE 200
CHICAGO IL
60618-4677
US

IV. Provider business mailing address

2923 N CALIFORNIA AVE STE 200
CHICAGO IL
60618-4677
US

V. Phone/Fax

Practice location:
  • Phone: 773-463-3460
  • Fax:
Mailing address:
  • Phone: 773-463-3460
  • Fax: 773-463-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011951
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: