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NPI Code Detail

MEDICARE: MR. ARIEL OMAR CHAVEZ PA-C

MEDICARE: MR. ARIEL OMAR CHAVEZ PA-C
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
1363A00000XPhysician Assistant085003644IL

General Provider Information

NPI Number : 1730411489
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ARIEL OMAR CHAVEZ PA-C
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST STE 850
Second Line :
City : CHICAGO
State : IL
Zip : 60611-3124
Country : US
Telephone Number : 312-695-6180
Fax Number : 312-695-6189
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST STE 850
Second Line :
City : CHICAGO
State : IL
Zip : 60611-3124
Country : US
Telephone Number : 312-695-6180
Fax Number : 312-695-6189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2010
Last Update Date : 06/30/2021

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