Provider Demographics
NPI:1588641104
Name:CHOH, JEFFREY T (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:CHOH
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 1:2520 ELISHA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099
Mailing Address - Country:US
Mailing Address - Phone:847-872-6259
Mailing Address - Fax:847-872-5716
Practice Address - Street 1:2361 PAYSPHERE CIRCLE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60674
Practice Address - Country:US
Practice Address - Phone:847-746-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471C3402X
IL036095510174400000X
IL036.0955102085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095510Medicaid
ILK21106Medicare ID - Type UnspecifiedAHRC
ILK13283Medicare ID - Type UnspecifiedGRC COOK COUNTY
ILK13281Medicare ID - Type UnspecifiedGMI LAKE COUNTY
IL036095510Medicaid
ILG51469Medicare UPIN
K15417Medicare UPIN
ILK13282Medicare ID - Type UnspecifiedGRC LAKE COUNTY