Provider Demographics
NPI:1265477699
Name:PRODROMOS, CHADWICK C (MD)
Entity Type:Individual
Prefix:
First Name:CHADWICK
Middle Name:C
Last Name:PRODROMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHADWICK
Other - Middle Name:C
Other - Last Name:PRODROMOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1714 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1441
Mailing Address - Country:US
Mailing Address - Phone:847-699-6810
Mailing Address - Fax:847-699-2854
Practice Address - Street 1:1714 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1441
Practice Address - Country:US
Practice Address - Phone:847-699-6810
Practice Address - Fax:847-699-2854
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062305207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062305Medicaid
IL1618365OtherBC/BS
IL1618365OtherBC/BS
ILK18412Medicare ID - Type Unspecified