MEDICARE: CHICAGO DIGESTIVE AND LIVER DISEASE SPECIALIST S 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
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1821326984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO DIGESTIVE AND LIVER DISEASE SPECIALIST S C

Provider Business Mailing Address
First Line	:	3740 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4727
Country	:	US
Telephone Number	:	630-889-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4727
Country	:	US
Telephone Number	:	630-889-9889
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID C CHUA
Credential	:	MD
Telephone Number	:	630-889-9889

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	10/24/2011

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