Healthcare Provider Details

I. General information

NPI: 1609004738
Provider Name (Legal Business Name): GEORGE CHENGALATHU GETTYS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD JAL FHCC, GEC/MH
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

6815 N WILDWOOD AVE
CHICAGO IL
60646-1308
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-8666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125056625
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number125056625
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number125056625
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: