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General NPI Number Information
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NPI Number | 1245701812
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Entity Type | Organization
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Legal Business Name | CHRYSALIS HEALTH OF ILLINOIS P.C.
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 1658 N MILWAUKEE AVE # 100-3840
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City | CHICAGO
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State | IL
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Zip | 60647-6905
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Country | US
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Telephone | 434-248-7508
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Fax |
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Provider Business Mailing Address
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Address Line | 136 E 76TH ST APT 8F
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City | NEW YORK
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State | NY
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Zip | 10021-2831
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Country | US
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Telephone | 434-248-7508
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JENNIFER HONE
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Credential | MD
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Telephone | 847-809-6796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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