| Illinois Internal Medicine Ltd | |
|
890 Garfield Ave Suite 209 Libertyville IL 60048-4723 | |
| (847) 367-3843 | |
| (847) 367-3063 |
| Full Name | Illinois Internal Medicine Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 890 Garfield Ave, Libertyville, Illinois |
| Authorized Official Name and Position | Mark James Chyna (PRESIDENT) |
| Authorized Official Contact | 8473673060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Internal Medicine Ltd 890 Garfield Ave # 209 Libertyville IL 60048-4723 Ph: (847) 367-3843 | Illinois Internal Medicine Ltd 890 Garfield Ave Suite 209 Libertyville IL 60048-4723 Ph: (847) 367-3843 |
| NPI Number | 1659597730 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 12/14/2008 |
| Medicare PECOS PAC ID | 8628173606 |
|---|---|
| Medicare Enrollment ID | O20070419000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659597730 | NPI | - | NPPES |
| 1740273507 | Other | IL | MARK CHYNA MD INDIV. NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 042-617825 (Illinois) | Primary |
| Provider Name | Mark J Chyna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740273507 PECOS PAC ID: 2163527144 Enrollment ID: I20070419000536 |
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