Healthcare Provider Details

I. General information

NPI: 1821326984
Provider Name (Legal Business Name): CHICAGO DIGESTIVE AND LIVER DISEASE SPECIALIST S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 10/24/2011
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

3740 W NORTH AVE
CHICAGO IL
60647-4727
US

V. Phone/Fax

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

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: MD
Phone: 630-889-9889