Provider Demographics
NPI:1669431078
Name:CHADWICK, ELLEN G (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:G
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4080
Mailing Address - Fax:312-227-9709
Practice Address - Street 1:225 E CHICAGO AVE # 20
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:312-227-9709
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360638752080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063875Medicaid
C45580Medicare UPIN