Provider Demographics
NPI:1104975176
Name:CHAN, MARIO HIM MING (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:HIM MING
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2101 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:111
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4185
Mailing Address - Country:US
Mailing Address - Phone:847-228-3200
Mailing Address - Fax:847-228-3740
Practice Address - Street 1:2101 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:111
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4185
Practice Address - Country:US
Practice Address - Phone:847-228-3200
Practice Address - Fax:847-228-3740
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036104346207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL85350Medicare ID - Type UnspecifiedMEDICARE ID #
ILH34995Medicare UPIN