Provider Demographics
NPI:1447325808
Name:CHILD STUDY CENTER
Entity type:Organization
Organization Name:CHILD STUDY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CHASNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-726-4011
Mailing Address - Street 1:180 N MICHIGAN AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7487
Mailing Address - Country:US
Mailing Address - Phone:312-726-4011
Mailing Address - Fax:312-726-4021
Practice Address - Street 1:180 N MICHIGAN AVE STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7487
Practice Address - Country:US
Practice Address - Phone:312-726-4011
Practice Address - Fax:312-726-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty