Provider Demographics
NPI:1720313240
Name:DR CHAGOYA PEDIATRICS LTD
Entity Type:Organization
Organization Name:DR CHAGOYA PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAGOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-788-0077
Mailing Address - Street 1:6545 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2313
Mailing Address - Country:US
Mailing Address - Phone:708-788-0077
Mailing Address - Fax:708-788-5620
Practice Address - Street 1:6545 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2313
Practice Address - Country:US
Practice Address - Phone:708-788-0077
Practice Address - Fax:708-788-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112461Medicaid
ILI25650Medicare UPIN