Basic Information
| Provider Information | |||||||||
| NPI: | 1144586538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSON | ||||||||
| FirstName: | CHANCEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 HARVESTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605275919 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5841 S MARYLAND AVE | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888240200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | 036146795 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine |
No ID Information.