Healthcare Provider Details

I. General information

NPI: 1689965477
Provider Name (Legal Business Name): ILLINOIS GASTROENTEROLOGY AND HEPATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 W NORTH AVE
CHICAGO IL
60647-4727
US

IV. Provider business mailing address

1S280 SUMMIT AVE COURT A
OAKBROOK TERRACE IL
60181-3984
US

V. Phone/Fax

Practice location:
  • Phone: 630-889-9889
  • Fax: 630-889-8977
Mailing address:
  • Phone: 630-889-9889
  • Fax: 630-889-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID C CHUA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-889-9889