Provider Demographics
NPI:1194786574
Name:INFECTIOUS DISEASE SPECIALISTS OF CHICAGO
Entity type:Organization
Organization Name:INFECTIOUS DISEASE SPECIALISTS OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRENHOLME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-2061
Mailing Address - Street 1:PO BOX 239D
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8018
Mailing Address - Country:US
Mailing Address - Phone:847-732-8087
Mailing Address - Fax:708-395-5223
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:SUITE 143
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-2061
Practice Address - Fax:312-942-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623155OtherBLUE SHIELD GROUP #
ILCJ6213OtherRR MEDICARE GROUP #
IL21623155OtherBLUE SHIELD GROUP #
ILCJ6213OtherRR MEDICARE GROUP #