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NPI Code Detail

MEDICARE: CHASE PHILLIPS PA

MEDICARE:   CHASE  PHILLIPS  PA
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
1363A00000XPhysician Assistant085011951IL

General Provider Information

NPI Number : 1740039940
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHASE PHILLIPS PA
Provider Business Mailing Address
First Line : 2923 N CALIFORNIA AVE STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60618-4677
Country : US
Telephone Number : 773-463-3460
Fax Number :
Provider Business Practice Location Address
First Line : 2923 N CALIFORNIA AVE STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60618-4677
Country : US
Telephone Number : 773-463-3460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2024
Last Update Date : 05/26/2026

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Directions to “ CHASE PHILLIPS PA” Practice Location

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