Memark, Chanachai
Memark, Chanachai is an individual health care provider with primary practice located at 430 Pennsylvania Ave , Glen Ellyn IL 60137-4464. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Memark, Chanachai can be contacted via phone (630) 469-9200.Contact Information
Primary practice address
430 Pennsylvania Ave
Glen Ellyn IL 60137-4464
Phone: (630) 469-9200
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 036046760 | Illinois |
Profile Details
| NPI number | 1336116771 |
|---|---|
| LBN Legal business name | Memark, Chanachai |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 3rd, 2006 |
| Last updated | Jan 27th, 2011 - about 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336116771 | NPPES |
| Illinois | MEDICAID | 03046760 |
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