Individual
PAUL P CHIANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 N MAIN ST, SECOND FLOOR, WHEATON, IL 60187-3112
(630) 614-4960
(630) 682-3727
Mailing address
1800 N MAIN ST, SECOND FLOOR, WHEATON, IL 60187-3112
(630) 614-4960
(630) 682-3727
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036091803
IL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036091803
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
07/11/2006
Last updated
02/27/2014
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