1114121209 NPI number — EMILY CHATSKIS MD PC

Table of content: (NPI 1114121209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114121209 NPI number — EMILY CHATSKIS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMILY CHATSKIS MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114121209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2592 VIOLET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60026-8033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-657-0053
Provider Business Mailing Address Fax Number:
773-275-1910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 N WOLF RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60090-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-520-2920
Provider Business Practice Location Address Fax Number:
847-520-2925
Provider Enumeration Date:
06/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHATSKIS
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-275-8042

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  036098264 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001626778 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9049076 . This is a "PHCS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 177490591478 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0007246298 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036098264 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".