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Organization

NORTHWEST CHICAGO MEDICAL LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JACK CHODZEN PT (PRESIDENT)
(773) 745-0391
Entity
Organization

Contact information

Practice address
2651 N LARAMIE AVE, CHICAGO, IL 60639-1613
(773) 745-0391
(773) 745-3506
Mailing address
2651 N LARAMIE AVE, CHICAGO, IL 60639-1613
(773) 745-0391
(773) 745-3506

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.000961
IL

Other

Enumeration date
11/15/2007
Last updated
11/12/2014
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