Basic Information
Provider Information
NPI: 1770580870
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOW
FirstName: MAY
MiddleName: T
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 W 22ND ST STE 200
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605231563
CountryCode: US
TelephoneNumber: 6305755000
FaxNumber:  
Practice Location
Address1: 5201 WILLOW SPRINGS RD
Address2: SUITE 260
City: LA GRANGE HIGHLANDS
State: IL
PostalCode: 605256537
CountryCode: US
TelephoneNumber: 7083541306
FaxNumber: 7083541538
Other Information
ProviderEnumerationDate: 07/05/2005
LastUpdateDate: 11/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/26/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X036087665ILY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

ID Information
IDTypeStateIssuerDescription
03608766505IL MEDICAID
11019671301ILRR MEDICARE INDIVIDUALOTHER


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