Individual provider · NPI-1
Dr. Pablo E Chagoya, M.D.
Pediatrics · Berwyn, IL
NPI number1235128075
StatusActive
Last updated in NPPESSep 22, 2011
Details
- NPI
- 1235128075
- Entity type
- Individual (NPI-1)
- Name
- Dr. Pablo E Chagoya
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 14, 2005
- Last updated
- Sep 22, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | 036112461 | IL | Yes |
| 207PP0204X | Emergency Medicine, Pediatric Emergency Medicine | 036112461 | IL |
Practice location
6545 Cermak RdBerwyn, IL 60402-2313
Phone 708-788-0077
Mailing address
6545 Cermak RdBerwyn, IL 60402-2313
Phone 708-788-0077
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