Basic Information
| Provider Information | |||||||||
| NPI: | 1154617421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEDRAUY | ||||||||
| FirstName: | JORGE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5145 N CALIFORNIA AVE | ||||||||
| Address2: | SWEDISH COVENANT HOSPITAL GME | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739893808 | ||||||||
| FaxNumber: | 7739891648 | ||||||||
| Practice Location | |||||||||
| Address1: | 5145 N CALIFORNIA AVE | ||||||||
| Address2: | SWEDISH COVENANT HOSPITAL GME | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739893808 | ||||||||
| FaxNumber: | 7739891648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2011 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 036134072 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 036.134072 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | F400274108 | 01 | IL | MEDICARE PTAN | OTHER |