Healthcare Provider Details

I. General information

NPI: 1912095746
Provider Name (Legal Business Name): LYNN G CHEHAB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DODGE AVE SCHOOL BASED HEALTH CENTER, H101
EVANSTON IL
60201-3449
US

IV. Provider business mailing address

1600 DODGE AVE SCHOOL BASED HEALTH CENTER, H101
EVANSTON IL
60201-3449
US

V. Phone/Fax

Practice location:
  • Phone: 847-424-7254
  • Fax:
Mailing address:
  • Phone: 847-424-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036116511
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: