Basic Information
| Provider Information | |||||||||
| NPI: | 1831365121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIS | ||||||||
| FirstName: | FLOAREA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 PENNY AVE | ||||||||
| Address2: | |||||||||
| City: | EAST DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601181454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478367015 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5025 N PAULINA ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606402772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732719040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036076375 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 036076375 | IL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036076375 | 01 | IL | LICENSE NUMBER | OTHER |