Basic Information
| Provider Information | |||||||||
| NPI: | 1992985592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JERRY CHOW, M.D., LTD. | ||||||||
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| OtherOrganizationName: | HAND THERAPY DIVISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15300 WEST AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083493388 | ||||||||
| FaxNumber: | 7083493334 | ||||||||
| Practice Location | |||||||||
| Address1: | 11947 S HARLEM AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083617929 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2007 | ||||||||
| LastUpdateDate: | 06/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | DEBRAE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7083493388 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 042-007044 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 31602242 | 01 | IL | BCBSIL | OTHER | CI2813 | 01 | PALMETTO GBA-RAILROAD MEDICARE | OTHER |