Provider Demographics
NPI:1114062585
Name:CHAPPEL, CONNIE D (MD)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:D
Last Name:CHAPPEL
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:PO BOX 6370
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-6370
Mailing Address - Country:US
Mailing Address - Phone:708-386-4411
Mailing Address - Fax:
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1205
Practice Address - Country:US
Practice Address - Phone:708-386-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036 071002Medicaid
IL31602115OtherBLUE CROSS BLUE SHIELD
IL036 071002Medicaid
IL036 071002Medicaid