MEDICARE: CHUN TONG CHEN M.D.

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	036046857	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200401	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740361898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUN TONG CHEN M.D.

Provider Business Mailing Address
First Line	:	9680 GOLF RD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1522
Country	:	US
Telephone Number	:	847-699-0800
Fax Number	:	847-296-5686

Provider Business Practice Location Address
First Line	:	11416 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4932
Country	:	US
Telephone Number	:	773-821-1414
Fax Number	:	773-821-1817

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	11/25/2015

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Directions to “ CHUN TONG CHEN M.D.” Practice Location

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