# MIDWEST PROSTATE-UROLOGY HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770766040
- **Authorized official:** DR. GERALD WALTER CHODAK M.D. (DIRECTOR / OWNER)
- **Authorized official phone:** (312) 969-2989

## Contact information

- **Practice address:** 4646 N MARINE DR, SUITE A5300, CHICAGO, IL 60640-5759
- **Practice address phone:** (773) 564-5006
- **Practice address fax:** (773) 564-5007
- **Mailing address:** 1937 W CORTLAND ST, CHICAGO, IL 60622-1041
- **Mailing address phone:** (312) 969-2989
- **Mailing address fax:** (773) 486-5974

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/10/2007
- **Last updated:** 12/10/2007