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General NPI Number Information
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NPI Number | 1013039239
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Entity Type | Organization
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Legal Business Name | ROBERT LENET MD, MAI PHAN MD, S.C
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 150 E HURON ST STE 906
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City | CHICAGO
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State | IL
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Zip | 60611-2946
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Country | US
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Telephone | 312-951-0501
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Fax | 312-951-0970
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Provider Business Mailing Address
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Address Line | 150 E HURON ST STE 906
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City | CHICAGO
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State | IL
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Zip | 60611-2946
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Country | US
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Telephone | 312-951-0501
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Fax | 312-951-0970
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MAI PHAN
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Credential | MD
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Telephone | 312-951-0501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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