Provider Demographics
NPI:1053370890
Name:CHAMLIN, SARAH LYNN (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:CHAMLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CHILDRENS PLAZA
Mailing Address - Street 2:# 107
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:312-227-6060
Mailing Address - Fax:312-227-9402
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:# 107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:312-227-6060
Practice Address - Fax:312-227-9402
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091042207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091042Medicaid
IL036091042Medicaid