Individual
JACK R CHAMBERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 BIESTERFIELD RD STE G01, WIMMER BUILDING, ELK GROVE VILLAGE, IL 60007-3372
(847) 981-3680
(847) 956-5122
Mailing address
900 S FRONTAGE RD, SUITE 325, WOODRIDGE, IL 60517-4903
(847) 981-3680
(847) 956-5122
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
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