Provider Demographics
NPI:1679585020
Name:CHMELL, SAMUEL J
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:CHMELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W TAYLOR ST
Mailing Address - Street 2:MC 743
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4319
Mailing Address - Country:US
Mailing Address - Phone:312-996-7161
Mailing Address - Fax:312-996-9025
Practice Address - Street 1:1701 S 1ST AVE STE 209
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-2400
Practice Address - Country:US
Practice Address - Phone:708-345-8814
Practice Address - Fax:708-345-8815
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057627207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15374Medicare UPIN
ILL93462Medicare ID - Type Unspecified