MEDICARE: EMILY CHATSKIS MD

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	207R00000X	Internal Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9049076	OTHER		PHCS
2	01626778	OTHER		BCBS

General Provider Information

NPI Number	:	1790771434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CHATSKIS MD

Provider Business Mailing Address
First Line	:	2592 VIOLET ST
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8033
Country	:	US
Telephone Number	:	847-657-0053
Fax Number	:	773-275-1910

Provider Business Practice Location Address
First Line	:	5327 N SHERIDAN RD
Second Line	:	STE D
City	:	CHICAGO
State	:	IL
Zip	:	60640-2531
Country	:	US
Telephone Number	:	773-275-8042
Fax Number	:	773-275-1910

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/08/2007

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Directions to “ EMILY CHATSKIS MD” Practice Location

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