MEDICARE: DR. DAVID SCOTT CHUDWIN M.D.

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	207K00000X	Allergy & Immunology Physician	036-064258	IL

General Provider Information

NPI Number	:	1669472262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SCOTT CHUDWIN M.D.

Provider Business Mailing Address
First Line	:	1 BRIARWOOD LN
Second Line	:
City	:	LINCOLNSHIRE
State	:	IL
Zip	:	60069-2500
Country	:	US
Telephone Number	:	847-272-4296
Fax Number	:	847-272-4177

Provider Business Practice Location Address
First Line	:	475 BROWN BLVD
Second Line	:
City	:	BOURBONNAIS
State	:	IL
Zip	:	60914-2325
Country	:	US
Telephone Number	:	815-933-5092
Fax Number	:	815-933-5494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/13/2021

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