Individual
BETTY FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1443
(773) 702-1000
Mailing address
150 HARVESTER DR STE 300, BURR RIDGE, IL 60527-5965
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01083940A
IN
208600000X
Surgery Physician
Primary
036.164960
IL
208600000X
Surgery Physician
34.013190
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2013
Last updated
10/27/2023
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