Provider Demographics
NPI:1063693323
Name:NORTHWEST CHICAGO MEDICAL LTD
Entity type:Organization
Organization Name:NORTHWEST CHICAGO MEDICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-745-0391
Mailing Address - Street 1:2651 N LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1613
Mailing Address - Country:US
Mailing Address - Phone:773-745-0391
Mailing Address - Fax:773-745-3506
Practice Address - Street 1:2651 N LARAMIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1613
Practice Address - Country:US
Practice Address - Phone:773-745-0391
Practice Address - Fax:773-745-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
IL203.000961332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical