Provider Demographics
NPI:1750755005
Name:CHERONIS, JOHN G (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:CHERONIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N LAKEVIEW AVE
Mailing Address - Street 2:APT 3402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1846
Mailing Address - Country:US
Mailing Address - Phone:773-929-2186
Mailing Address - Fax:
Practice Address - Street 1:2500 N LAKEVIEW AVE
Practice Address - Street 2:APT 3402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1846
Practice Address - Country:US
Practice Address - Phone:773-929-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.048670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist