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General NPI Number Information
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NPI Number | 1659678290
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Entity Type | Organization
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Legal Business Name | RICHARD C L CHEN MD LTD
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 415 WEST MAIN STREET SUITE 4
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City | COLLINSVILLE
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State | IL
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Zip | 62234
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Country | US
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Telephone | 618-345-1112
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Fax | 618-345-1113
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Provider Business Mailing Address
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Address Line | 415 WEST MAIN ST. SUITE 4
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City | COLLINSVILLE
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State | IL
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Zip | 62234
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Country | US
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Telephone | 618-345-1112
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Fax | 618-345-1113
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAU LIANG CHEN
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Credential | M.D.
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Telephone | 618-345-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-53838
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License Number State | IL
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