Provider Demographics
NPI:1679505051
Name:CHALUPCZAK, ROBERT JAROSLAW (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAROSLAW
Last Name:CHALUPCZAK
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 1:4301 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2670
Mailing Address - Country:US
Mailing Address - Phone:708-425-5500
Mailing Address - Fax:798-425-0771
Practice Address - Street 1:4301 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2670
Practice Address - Country:US
Practice Address - Phone:708-425-5500
Practice Address - Fax:798-425-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098369Medicaid
ILK30001Medicare ID - Type Unspecified
IL036098369Medicaid