Organization
JASMINE WANG CHAO, D.O., LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CHAO PH.D. (CORP. SECRETARY)
(847) 657-8588
Entity
Organization
Contact information
Practice address
1308 WAUKEGAN RD, SUITE 202, GLENVIEW, IL 60025-3070
(847) 657-8588
(847) 657-8778
Mailing address
PO BOX 1666, SKOKIE, IL 60076-8666
(847) 657-8588
(847) 657-8778
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036107878
IL
207QA0000X
Adolescent Medicine (Family Medicine) Physician
036107878
IL
207QA0505X
Adult Medicine Physician
036107878
IL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
036107878
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107878
—
IL
Enumeration date
12/29/2009
Last updated
04/28/2010
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