Provider Demographics
NPI:1477539575
Name:CHIN, HAROLD W (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:W
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1659
Mailing Address - Country:US
Mailing Address - Phone:847-535-7917
Mailing Address - Fax:847-535-7801
Practice Address - Street 1:75 REMITTANCE DR
Practice Address - Street 2:SUITE 1951
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60675-1001
Practice Address - Country:US
Practice Address - Phone:847-535-7917
Practice Address - Fax:847-535-7801
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36065053207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36065053Medicaid
IL36065053Medicaid
ILL74525Medicare ID - Type Unspecified