Provider Demographics
NPI:1801816517
Name:CHAVEZ, LORITZ (MD)
Entity Type:Individual
Prefix:
First Name:LORITZ
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
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:PO BOX 806338
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4124
Mailing Address - Country:US
Mailing Address - Phone:312-593-4236
Mailing Address - Fax:773-582-1380
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-961-4426
Practice Address - Fax:414-961-3393
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087770207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031601474OtherBLUE SHIELD
IL036087770Medicaid
P00225879OtherRAILROAD MEDICARE
F96871Medicare UPIN
P00225879OtherRAILROAD MEDICARE