Healthcare Provider Details

I. General information

NPI: 1689863029
Provider Name (Legal Business Name): FRANCISCO L CHUY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 W LAWRENCE AVE
CHICAGO IL
60625-7236
US

IV. Provider business mailing address

3610 W LAWRENCE AVE
CHICAGO IL
60625-7236
US

V. Phone/Fax

Practice location:
  • Phone: 773-267-0055
  • Fax:
Mailing address:
  • Phone: 773-267-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036087894
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: