Provider Demographics
NPI:1093813388
Name:CHON, MARIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:CHON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:CHON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:414 S OAK PARK AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3839
Mailing Address - Country:US
Mailing Address - Phone:708-848-7334
Mailing Address - Fax:708-848-7335
Practice Address - Street 1:414 S OAK PARK AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3839
Practice Address - Country:US
Practice Address - Phone:708-848-7334
Practice Address - Fax:708-848-7335
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004754213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480019376OtherRAILROAD MEDICARE
374450Medicare ID - Type Unspecified
U57997Medicare UPIN
IL016004754Medicare ID - Type Unspecified