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
Update your record
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