Organization
JUAN CHEDIAK MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH BRUNDAGE (PRACTICE MANAGER)
(708) 366-7177
Entity
Organization
Contact information
Practice address
3000 N HALSTED ST, SUITE 600, CHICAGO, IL 60657-5188
(773) 868-0380
(773) 868-0382
Mailing address
3000 N HALSTED ST, SUITE 600, CHICAGO, IL 60657-5188
(773) 868-0380
(773) 868-0382
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036-048665
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048665
—
IL
01
—
213425
MEDICARE
IL
01
—
363965106
BLUE CROSS BLUE SHIELD ILLINOIS
IL
Enumeration date
04/01/2009
Last updated
04/01/2009
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