Organization
MAXIM A CHASANOV, MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAXIM ALEXIS CHASANOV M.D. (PRESIDENT)
(847) 363-0817
Entity
Organization
Contact information
Practice address
1535 LAKE COOK RD, SUITE 112, NORTHBROOK, IL 60062-1447
(847) 363-0817
(847) 509-7984
Mailing address
1535 LAKE COOK ROAD, SUITE 112, NORTHBROOK, IL 60062-1447
(847) 363-0817
(847) 509-7984
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036084874
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1606 781
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
02/26/2007
Last updated
12/24/2008
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