Provider Demographics
NPI:1588974174
Name:IOAN D CHEREGI MD SC
Entity type:Organization
Organization Name:IOAN D CHEREGI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IOAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHEREGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD SC
Authorized Official - Phone:773-539-7886
Mailing Address - Street 1:6374 N LINCOLN AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1283
Mailing Address - Country:US
Mailing Address - Phone:773-539-7886
Mailing Address - Fax:773-539-8160
Practice Address - Street 1:6374 N LINCOLN AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1283
Practice Address - Country:US
Practice Address - Phone:773-539-7886
Practice Address - Fax:773-539-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center