Provider Demographics
NPI:1114121209
Name:EMILY CHATSKIS MD PC
Entity Type:Organization
Organization Name:EMILY CHATSKIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATSKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-275-8042
Mailing Address - Street 1:2592 VIOLET ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8033
Mailing Address - Country:US
Mailing Address - Phone:847-657-0053
Mailing Address - Fax:773-275-1910
Practice Address - Street 1:505 N WOLF RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3027
Practice Address - Country:US
Practice Address - Phone:847-520-2920
Practice Address - Fax:847-520-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098264261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001626778OtherBLUE CROSS BLUE SHIELD
IL9049076OtherPHCS
IL177490591478OtherHUMANA
IL0007246298OtherAETNA
IL036098264Medicaid
IL212122Medicare ID - Type Unspecified
IL0001626778OtherBLUE CROSS BLUE SHIELD