Basic Information
| Provider Information | |||||||||
| NPI: | 1598775728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESTMED S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 S SOUTHMEADOW LN | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600454833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475876112 | ||||||||
| FaxNumber: | 8475876113 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S ATKINSON RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | GRAYSLAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600307821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475876112 | ||||||||
| FaxNumber: | 8475876113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 11/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | FU | ||||||||
| AuthorizedOfficialFirstName: | YIPING | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8475876112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 036097168 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 04932467 | 01 | IL | BLUE CROSS/SHIELD | OTHER | DD7448 | 01 | IL | RAIL ROAD MEDICARE | OTHER | 036097168 | 05 | IL | MEDICAID |