Individual
DR. JACK ROBERT CHULENGARIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1200 N GREEN BAY RD, WAUKEGAN, IL 60085-2246
(847) 249-3338
Mailing address
1200 N GREEN BAY RD, WAUKEGAN, IL 60085-2246
(847) 249-3338
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016002637
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04932042
BCBS
IL
01
—
480025062
RAILROAD MEDICARE
IL
Enumeration date
08/09/2005
Last updated
04/25/2012
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