Healthcare Provider Details

I. General information

NPI: 1134174758
Provider Name (Legal Business Name): THOMAS JOHN CHORBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HOWARD ST STE 105
EVANSTON IL
60202-3878
US

IV. Provider business mailing address

1107 CLEVELAND ST
EVANSTON IL
60202-2114
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-4477
  • Fax: 773-561-9277
Mailing address:
  • Phone: 773-561-4477
  • Fax: 773-561-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036050009
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036050009
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036050009
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036050009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: