Healthcare Provider Details

I. General information

NPI: 1447325808
Provider Name (Legal Business Name): CHILD STUDY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N MICHIGAN AVE STE 700
CHICAGO IL
60601-7487
US

IV. Provider business mailing address

180 N MICHIGAN AVE STE 700
CHICAGO IL
60601-7487
US

V. Phone/Fax

Practice location:
  • Phone: 312-726-4011
  • Fax: 312-726-4021
Mailing address:
  • Phone: 312-726-4011
  • Fax: 312-726-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. IRA JAY CHASNOFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-726-4011