MEDICARE: DR. HEDELITA S MONTENEGRO-YANEZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	036054607	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508924614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEDELITA S MONTENEGRO-YANEZA MD

Provider Business Mailing Address
First Line	:	4039 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639
Country	:	US
Telephone Number	:	773-227-2040
Fax Number	:	773-227-1210

Provider Business Practice Location Address
First Line	:	4039 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639
Country	:	US
Telephone Number	:	773-227-2040
Fax Number	:	773-227-1210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/01/2017

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Directions to “ DR. HEDELITA S MONTENEGRO-YANEZA MD” Practice Location

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