Maxim a Chasanov, MD SC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036084874 Issued in IL

Legal business name

MAXIM A CHASANOV, MD SC

Practice address

1535 Lake Cook Rd
Suite 112
Northbrook, IL 60062-1447

Phone

(847) 363-0817

Fax

(847) 509-7984

NPI assigned

Feb 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Maxim Alexis Chasanov, M.D.

Title

President

Phone

(847) 363-0817

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230076800000",
    "number": "1033245105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 LAKE COOK ROAD",
            "address_2": "SUITE 112",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621447",
            "telephone_number": "847-363-0817",
            "fax_number": "847-509-7984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 LAKE COOK RD",
            "address_2": "SUITE 112",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621447",
            "telephone_number": "847-363-0817",
            "fax_number": "847-509-7984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM A CHASANOV, MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-12-24",
        "status": "A",
        "authorized_official_last_name": "CHASANOV",
        "authorized_official_first_name": "MAXIM",
        "authorized_official_middle_name": "ALEXIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-363-0817",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036084874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "1606 781",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Matsko
• Kimberly Matthews, LCPC
• Maria Ann Mattox, LPC
• Milana Matz, O.D.
• Madelyn Matzuka
• Maxwell Medical Group, SC
• Emily Mayer
• Shalae Mayville
• Antonio Mazza, OTD OTR/L
• Tracy L McCafferty, LCSW

• Psychiatry Physician in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.