MEDICARE: DR. RONALD CHEDIAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036108590	IL

General Provider Information

NPI Number	:	1184627861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD CHEDIAK MD

Provider Business Mailing Address
First Line	:	3000 W DEYOUNG ST
Second Line	:	STE 524
City	:	MARION
State	:	IL
Zip	:	62959-5551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 W DEYOUNG ST
Second Line	:	STE 524
City	:	MARION
State	:	IL
Zip	:	62959-5551
Country	:	US
Telephone Number	:	618-993-1421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/07/2025

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Directions to “ DR. RONALD CHEDIAK MD” Practice Location

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