Provider Demographics
NPI:1770766040
Name:MIDWEST PROSTATE-UROLOGY HEALTH
Entity type:Organization
Organization Name:MIDWEST PROSTATE-UROLOGY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CHODAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-969-2989
Mailing Address - Street 1:1937 W CORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1041
Mailing Address - Country:US
Mailing Address - Phone:312-969-2989
Mailing Address - Fax:773-486-5974
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:SUITE A5300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-564-5006
Practice Address - Fax:773-564-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center