=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760770481
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA RHODORA ESPINAS CHAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2011
-----------------------------------------------------
Last Update Date | 02/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15209 LINDEN DR
-----------------------------------------------------
City | OAK FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60452-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-787-7821
-----------------------------------------------------
Fax | 773-305-2984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15209 LINDEN DR
-----------------------------------------------------
City | OAK FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60452-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-787-7821
-----------------------------------------------------
Fax | 773-305-2984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 125059039
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------