Provider Demographics
NPI:1447400528
Name:CHAPUT, JOYCE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:MARY
Last Name:CHAPUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:MARY
Other - Last Name:LIBUNAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5841 S MARYLAND AVE # MC5068
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:312-399-0796
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # MC5068
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:312-399-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051412207P00000X
CAA109125207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447400528Medicaid
CACI958ZMedicare PIN