Healthcare Provider Details

I. General information

NPI: 1306858725
Provider Name (Legal Business Name): CHICAGO UROLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

4143 S DREXEL BLVD
CHICAGO IL
60653-2815
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7159
  • Fax: 773-296-7939
Mailing address:
  • Phone: 773-924-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: TRACI P BECK
Title or Position: MEMBER
Credential: MD
Phone: 773-924-2944