Provider Demographics
NPI:1508831660
Name:CHOW, JERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:CHOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4600
Mailing Address - Country:US
Mailing Address - Phone:708-349-3388
Mailing Address - Fax:708-349-3334
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-349-3388
Practice Address - Fax:708-349-3334
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-073-830208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
990007792OtherPALMETTO GBA-RAILROAD MEDICARE
IL0031602242OtherBCBSIL
IL036073830Medicaid
IL036073830Medicaid
K49811Medicare PIN