Provider Demographics
NPI:1164422341
Name:CHOU, PAULINE (MD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:BOX 17
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-4000
Mailing Address - Fax:
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:PATHOLOGY LAB
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068444207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068444Medicaid
IL021622158OtherCMMG BLUE SHIELD
IL702730Medicare ID - Type UnspecifiedCMMG COOK CNTY MDCR
IL036068444Medicaid
ILL86832Medicare ID - Type UnspecifiedWILL CNTY MDCR
ILL86829Medicare ID - Type UnspecifiedCOOK CNTY MDCR
IL021622158OtherCMMG BLUE SHIELD