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General NPI Number Information
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NPI Number | 1316310782
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Entity Type | Organization
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Legal Business Name | CHICAGO MEDICAL AND SURGICAL SPECIALISTS, S. C.
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Dates
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Enumeration Date | 11/07/2015
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Last Update Date | 11/07/2015
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Provider Practice Location Address
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Address Line | 1645 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60622-2543
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Country | US
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Telephone | 224-404-1097
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Fax |
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Provider Business Mailing Address
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Address Line | 474 N LAKE SHORE DR 5206
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City | CHICAGO
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State | IL
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Zip | 60611-3400
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Country | US
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Telephone | 317-908-8833
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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 | DR. SAMSON M. CHAN
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Credential | M. D.
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Telephone | 317-908-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036134419
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 036134419
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License Number State | IL
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