Provider Demographics
NPI:1992985592
Name:JERRY CHOW, M.D., LTD.
Entity type:Organization
Organization Name:JERRY CHOW, M.D., LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEBRAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-349-3388
Mailing Address - Street 1:15300 WEST AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4600
Mailing Address - Country:US
Mailing Address - Phone:708-349-3388
Mailing Address - Fax:708-349-3334
Practice Address - Street 1:11947 S HARLEM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1482
Practice Address - Country:US
Practice Address - Phone:708-361-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-007044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31602242OtherBCBSIL
CI2813OtherPALMETTO GBA-RAILROAD MEDICARE
CI2813OtherPALMETTO GBA-RAILROAD MEDICARE
768440Medicare PIN