Provider Demographics
NPI:1356575690
Name:CHWAJOL, MARK (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:CHWAJOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MAREK
Other - Middle Name:
Other - Last Name:CHWAJOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1350 N WELLS ST
Mailing Address - Street 2:APT. F 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1936
Mailing Address - Country:US
Mailing Address - Phone:646-675-2670
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:886-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.123878207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery