# CHICAGO MEDICAL AND SURGICAL SPECIALISTS, S. C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316310782
- **Authorized official:** DR. SAMSON M. CHAN M. D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (317) 908-8833

## Contact information

- **Practice address:** 1645 W NORTH AVE, CHICAGO, IL 60622-2543
- **Practice address phone:** (224) 404-1097
- **Mailing address:** 474 N LAKE SHORE DR, 5206, CHICAGO, IL 60611-3400
- **Mailing address phone:** (317) 908-8833

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | 036134419 | IL | Yes |
| 208600000X | Surgery Physician | 036134419 | IL | — |

## Other

- **Enumeration date:** 11/07/2015
- **Last updated:** 11/07/2015