Provider Demographics
NPI:1609977305
Name:CHITWOOD, RICK A (DO)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:A
Last Name:CHITWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3151
Mailing Address - Country:US
Mailing Address - Phone:815-344-4499
Mailing Address - Fax:815-344-4479
Practice Address - Street 1:3922 MERCY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3179
Practice Address - Country:US
Practice Address - Phone:815-344-4499
Practice Address - Fax:815-344-4479
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL035-083318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083318 2Medicaid
WICHITWRICOtherMERCY CARE NUMBER
WICHITWRICOtherMERCY CARE NUMBER
IL036083318 2Medicaid