Provider Demographics
NPI:1063605889
Name:MAAYAN-FRANK, CHANNA (MD)
Entity type:Individual
Prefix:
First Name:CHANNA
Middle Name:
Last Name:MAAYAN-FRANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HANANIA STREET
Mailing Address - Street 2:
Mailing Address - City:JERUSALEM
Mailing Address - State:IL
Mailing Address - Zip Code:93106
Mailing Address - Country:IL
Mailing Address - Phone:297-258-4451
Mailing Address - Fax:
Practice Address - Street 1:7 HANANIA STREET
Practice Address - Street 2:
Practice Address - City:JERUSALEM
Practice Address - State:IL
Practice Address - Zip Code:93106
Practice Address - Country:IL
Practice Address - Phone:297-258-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59817208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics