Provider Demographics
NPI:1417127622
Name:CYRIL M CHRABOT MD SC
Entity Type:Organization
Organization Name:CYRIL M CHRABOT MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHRABOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-586-2099
Mailing Address - Street 1:6925 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2319
Mailing Address - Country:US
Mailing Address - Phone:773-586-2099
Mailing Address - Fax:773-586-8089
Practice Address - Street 1:6925 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2319
Practice Address - Country:US
Practice Address - Phone:773-586-2099
Practice Address - Fax:773-586-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021629442OtherBLUE CROSS BLUE SHIELD
IL0021629442OtherBLUE CROSS BLUE SHIELD
ILC45484Medicare UPIN
ILDG8574Medicare PIN