Provider Demographics
NPI:1659454577
Name:JACK CHULENGARIAN DPM PC
Entity Type:Organization
Organization Name:JACK CHULENGARIAN DPM PC
Other - Org Name:LAKE COUNTY FOOT & ANKLE LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHULENGARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-249-3338
Mailing Address - Street 1:1200 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2246
Mailing Address - Country:US
Mailing Address - Phone:847-249-3338
Mailing Address - Fax:847-249-8218
Practice Address - Street 1:1200 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2246
Practice Address - Country:US
Practice Address - Phone:847-249-3338
Practice Address - Fax:847-249-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932042OtherBCBS
ILCK7567OtherRAILROAD MEDICARE
IL04932042OtherBCBS
ILCK7567OtherRAILROAD MEDICARE