Provider Demographics
NPI:1588777122
Name:HAN - CHANG, CHAE (MD)
Entity type:Individual
Prefix:
First Name:CHAE
Middle Name:
Last Name:HAN - CHANG
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 1:731 S ILLINOIS ROUTE 21
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3813
Mailing Address - Country:US
Mailing Address - Phone:847-566-3337
Mailing Address - Fax:847-816-3166
Practice Address - Street 1:731 S ILLINOIS ROUTE 21
Practice Address - Street 2:SUITE 130
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3813
Practice Address - Country:US
Practice Address - Phone:847-566-3337
Practice Address - Fax:847-816-3166
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04930281OtherBLUE CROSS BLUE SHIELD
IL036096132Medicaid
IL916950Medicare PIN
IL04930281OtherBLUE CROSS BLUE SHIELD
G80595Medicare UPIN
IL110233104Medicare PIN