Provider Demographics
NPI:1700901576
Name:CHICAGO CHATHAM MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:CHICAGO CHATHAM MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-753-5800
Mailing Address - Street 1:6800 S CONSTANCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1506
Mailing Address - Country:US
Mailing Address - Phone:773-753-5800
Mailing Address - Fax:773-684-5867
Practice Address - Street 1:2011 E 75TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3607
Practice Address - Country:US
Practice Address - Phone:773-753-5800
Practice Address - Fax:773-753-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Not Answered2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Multi-Specialty
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAK8606800OtherDEA