Individual
CHANACHAI MEMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 PENNSYLVANIA AVE, GLEN ELLYN, IL 60137-4464
(630) 469-9200
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036046760
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03046760
—
IL
Enumeration date
03/03/2006
Last updated
01/27/2011
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