Individual
JACK R CHAMBERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036086925
IL
207RI0011X
Interventional Cardiology Physician
Primary
036-086925
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720371669
NPI GROUP PRACTICE
IL
01
—
IL6304015
MEDICARE PTAN LOC 16
IL
01
—
IL6305015
MEDICARE PTAN LOC 15
IL
01
—
P01008734
RRMC PTAN
IL
Enumeration date
05/18/2006
Last updated
04/10/2015
Update your record
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