Provider Demographics
NPI:1205219144
Name:HEALTHY CHICAGO PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:HEALTHY CHICAGO PRIMARY CARE, PLLC
Other - Org Name:HEALTHY CHICAGO PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-746-6999
Mailing Address - Street 1:2077 N CLYBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4003
Mailing Address - Country:US
Mailing Address - Phone:773-886-1500
Mailing Address - Fax:
Practice Address - Street 1:2077 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4003
Practice Address - Country:US
Practice Address - Phone:773-886-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.133054261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care