Healthcare Provider Details

I. General information

NPI: 1609977305
Provider Name (Legal Business Name): RICK A CHITWOOD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/27/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 MERCY DR
MCHENRY IL
60050-3179
US

IV. Provider business mailing address

3922 MERCY DR
MCHENRY IL
60050-3151
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-4499
  • Fax: 815-344-4479
Mailing address:
  • Phone: 815-344-4499
  • Fax: 815-344-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number035-083318
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036083318 2
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 2
IdentifierCHITWRIC
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerMERCY CARE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: