Chasanov, Maxim A.

Chasanov, Maxim A. is an sole proprietor health care provider with primary practice located at 1786 Moon Lake Blvd Suite 104, Hoffman Estates IL 60169-5029. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Chasanov, Maxim A. can be contacted via phone (847) 755-8090.

Contact Information

Primary practice address
1786 Moon Lake Blvd Suite 104 Hoffman Estates IL 60169-5029
Phone: (847) 755-8090
Fax: (847) 843-7393
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 036084874 Illinois

Profile Details

NPI number 1124028584
LBN Legal business name Chasanov, Maxim A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 28th, 2005
Last updated Nov 16th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124028584 NPPES
Illinois MEDICAID 036084874
Illinois Other 1606781

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