Provider Demographics
NPI:1700869450
Name:CHAVEZ, MILTON C (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:C
Last Name:CHAVEZ
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 1:1509 N WESTERN AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2416
Mailing Address - Country:US
Mailing Address - Phone:773-227-3303
Mailing Address - Fax:
Practice Address - Street 1:1509 N WESTERN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2416
Practice Address - Country:US
Practice Address - Phone:773-227-3303
Practice Address - Fax:773-897-5848
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079016Medicaid
ILK40421Medicare PIN
ILE41102Medicare UPIN