MEDICARE: C T CHEN M D S 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	207Q00000X	Family Medicine Physician	036046856	IL

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932125051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C T CHEN M D S C

Provider Business Mailing Address
First Line	:	2220 ALLEN DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6259 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2529
Country	:	US
Telephone Number	:	773-752-2767
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHAO CHEN
Credential	:	M.D.
Telephone Number	:	847-272-7460

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/23/2012

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Directions to “C T CHEN M D S C ” Practice Location

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