Healthcare Provider Details

I. General information

NPI: 1932108396
Provider Name (Legal Business Name): CHICAGO HEAD AND NECK SURGICAL SPECIALISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BARRINGTON RD SUITE #305
HOFFMAN ESTATES IL
60194-1057
US

IV. Provider business mailing address

PO BOX 64568
PHOENIX AZ
85082-4568
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-2000
  • Fax:
Mailing address:
  • Phone: 477-819-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AJAY K. CHAUHAN
Title or Position: CHAIRMAN
Credential: D.O.
Phone: 847-843-2000