MEDICARE: M CHAVEZ MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036079016	IL

General Provider Information

NPI Number	:	1134446065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M CHAVEZ MD SC

Provider Business Mailing Address
First Line	:	1509 N WESTERN AVE UNIT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2416
Country	:	US
Telephone Number	:	773-227-3303
Fax Number	:	773-897-5848

Provider Business Practice Location Address
First Line	:	1509 N WESTERN AVE UNIT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2416
Country	:	US
Telephone Number	:	773-227-3303
Fax Number	:	773-897-5848

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	MILTON C CHAVEZ
Credential	:	MD
Telephone Number	:	773-342-1212

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	11/18/2021

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