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NPI Code Detail

MEDICARE: JUAN L TELLEZ MD

MEDICARE: JUAN L TELLEZ 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
1207Q00000XFamily Medicine Physician036098451IL

General Provider Information

NPI Number : 1770534026
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN L TELLEZ MD
Provider Business Mailing Address
First Line : 9206 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-978-0707
Fax Number : 773-978-6140
Provider Business Practice Location Address
First Line : 9206 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-978-0707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 02/21/2019

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Directions to “ JUAN L TELLEZ MD” Practice Location

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