Basic Information
| Provider Information | |||||||||
| NPI: | 1508217605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHINWALA | ||||||||
| FirstName: | HUZEFA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 616 S OAKLEY BLVD | ||||||||
| Address2: | APT 2 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306649252 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 HEALTH CARE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622461154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186641230 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2016 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 125068215 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2019024481 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01082371A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036149614 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.