Healthcare Provider Details

I. General information

NPI: 1700901576
Provider Name (Legal Business Name): CHICAGO CHATHAM MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 E 75TH ST SUITE 111
CHICAGO IL
60649-3607
US

IV. Provider business mailing address

6800 S CONSTANCE AVE
CHICAGO IL
60649-1506
US

V. Phone/Fax

Practice location:
  • Phone: 773-753-5800
  • Fax: 773-753-8819
Mailing address:
  • Phone: 773-753-5800
  • Fax: 773-684-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GAYLE KATES
Title or Position: DIRECTOR
Credential:
Phone: 773-753-5800