MEDICARE: CHRYSALIS HEALTH OF ILLINOIS P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1104823954	OTHER	CA	NPI

General Provider Information

NPI Number	:	1245701812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRYSALIS HEALTH OF ILLINOIS P.C.

Provider Business Mailing Address
First Line	:	136 E 76TH ST APT 8F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2831
Country	:	US
Telephone Number	:	434-248-7508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1658 N MILWAUKEE AVE # 100-3840
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6905
Country	:	US
Telephone Number	:	434-248-7508
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JENNIFER HONE
Credential	:	MD
Telephone Number	:	847-809-6796

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	04/22/2021

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Directions to “CHRYSALIS HEALTH OF ILLINOIS P.C. ” Practice Location

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