MEDICARE: DR. KENNETH D CHI 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	207RG0100X	Gastroenterology Physician	036104080	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00150736	OTHER		MEDICARE RAILROAD

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

General Provider Information

NPI Number	:	1821070939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH D CHI MD

Provider Business Mailing Address
First Line	:	2501 COMPASS RD
Second Line	:	SUITE 130
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8000
Country	:	US
Telephone Number	:	847-677-1170
Fax Number	:	847-677-1233

Provider Business Practice Location Address
First Line	:	2501 COMPASS RD
Second Line	:	SUITE 130
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8000
Country	:	US
Telephone Number	:	847-677-1170
Fax Number	:	847-677-1233

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	12/16/2021

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Directions to “ DR. KENNETH D CHI MD” Practice Location

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