MEDICARE: DR. CARMEN PATRICIA MACIAS HUERTA M.D.

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	207R00000X	Internal Medicine Physician	036085331	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036085331	IL
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	036-085331	IL
4	207RP1001X	Pulmonary Disease Physician	036085331	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02215074	OTHER	IL	BLUE SHIELD PROVIDER NUMB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891753588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN PATRICIA MACIAS HUERTA M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE STE 412
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3532
Country	:	US
Telephone Number	:	773-293-4362
Fax Number	:	847-763-8937

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 412
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3532
Country	:	US
Telephone Number	:	773-293-4362
Fax Number	:	847-763-8937

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/25/2024

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Directions to “ DR. CARMEN PATRICIA MACIAS HUERTA M.D.” Practice Location

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