Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Theodore Tae-Shik Park, MD

Individual provider Family Medicine Physician · NPI 1194947648

Dr. Theodore Tae-Shik Park, MD is a Family Practice in Chicago, Illinois. Graduated from Northwestern University Feinberg Medical School in 2004, 22 years ago. Practices with Lawndale Christian Health Center, a 123-clinician group and accepts Medicare assignment. Licensed in Indiana and Ohio.

Years since qualifying
22
Trained at
Northwestern University Feinberg Medical School
Licensed in
IN, OH
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3860 W Ogden Ave
Chicago, IL 60623-2460
Phone: (872) 588-3000
Fax: (872) 588-3561
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 01065753A (IN)
Family Medicine Physician Taxonomy 207Q00000X · Licence 35.092012 (OH)

Record details

NPI number1194947648
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMay 3, 2007
Last updated in NPPESFebruary 23, 2017

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolNORTHWESTERN UNIVERSITY FEINBERG MEDICAL SCHOOL
Graduated 2004 (22 years in practice)
Group practice Lawndale Christian Health Center — 123 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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