Provider Demographics
NPI:1902978257
Name:CHAVEZ, ARIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:ARIEL
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 597202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-927-7573
Mailing Address - Fax:773-927-7382
Practice Address - Street 1:4608 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609
Practice Address - Country:US
Practice Address - Phone:773-927-7573
Practice Address - Fax:773-927-7382
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
363306485OtherTAX ID
IL036054596Medicaid
IL21606887OtherBCBS
IL036054596Medicaid
IL491890Medicare ID - Type Unspecified