MEDICARE: DR. NATHALIE D MCCAMMON-CHASE MD

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	207Q00000X	Family Medicine Physician	036104978	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619414	OTHER	IL	BCBS GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568409720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHALIE D MCCAMMON-CHASE MD

Provider Business Mailing Address
First Line	:	720 LAKE ST
Second Line	:	SUITE 101
City	:	OAK PARK
State	:	IL
Zip	:	60301-1424
Country	:	US
Telephone Number	:	708-358-0791
Fax Number	:	708-948-7523

Provider Business Practice Location Address
First Line	:	720 LAKE ST
Second Line	:	SUITE 101
City	:	OAK PARK
State	:	IL
Zip	:	60301-1424
Country	:	US
Telephone Number	:	708-358-0791
Fax Number	:	708-948-7523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/27/2021

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