Provider Demographics
NPI:1578790184
Name:RICHARD D. CHESSICK, M.D., PH.D.,P.C.
Entity Type:Organization
Organization Name:RICHARD D. CHESSICK, M.D., PH.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:CHESSICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:847-329-9598
Mailing Address - Street 1:9400 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1106
Mailing Address - Country:US
Mailing Address - Phone:847-329-9598
Mailing Address - Fax:
Practice Address - Street 1:9400 DRAKE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60203-1106
Practice Address - Country:US
Practice Address - Phone:847-329-9598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-337542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL998130Medicare PIN