MEDICARE: MR. ARIEL CHAVEZ 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	036054596	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	363306485	OTHER		TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	21606887	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1902978257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARIEL CHAVEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 597202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659
Country	:	US
Telephone Number	:	773-927-7573
Fax Number	:	773-927-7382

Provider Business Practice Location Address
First Line	:	4608 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609
Country	:	US
Telephone Number	:	773-927-7573
Fax Number	:	773-927-7382

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	04/30/2010

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