Individual
BAMPEN CHARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3800 W 203RD ST, STE 202, OLYMPIA FIELDS, IL 60461-1184
(708) 679-2660
(708) 503-3861
Mailing address
1040 SIERRA DR, SUITE 400, GREENWOOD, IN 46143-7240
(317) 528-4253
(317) 865-8319
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036046854
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010025527
RR MEDICARE
—
01
—
01616205
BLUE SHIELD
—
05
—
036046854
—
IL
01
—
05-0540914
WELLGROUP TAX ID
IL
Enumeration date
01/04/2006
Last updated
08/08/2013
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