Dr Chagoya Pediatrics LTD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036112461 Issued in IL

Legal business name

DR CHAGOYA PEDIATRICS LTD

Practice address

6545 Cermak Rd
Berwyn, IL 60402-2313

Phone

(708) 788-0077

Fax

(708) 788-5620

NPI assigned

Oct 16, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pablo Chagoya, M.D.

Title

President

Phone

(708) 788-0077

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316736000000",
    "number": "1720313240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022313",
            "telephone_number": "708-788-0077",
            "fax_number": "708-788-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022313",
            "telephone_number": "708-788-0077",
            "fax_number": "708-788-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR CHAGOYA PEDIATRICS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-16",
        "last_updated": "2011-09-23",
        "status": "A",
        "authorized_official_last_name": "CHAGOYA",
        "authorized_official_first_name": "PABLO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-788-0077",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036112461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112461",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.