Healthcare Provider Details

I. General information

NPI: 1235259656
Provider Name (Legal Business Name): SANUKA MEDICAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BARTLETT PLZ
BARTLETT IL
60103-4234
US

IV. Provider business mailing address

114 BARTLETT PLZ
BARTLETT IL
60103-4234
US

V. Phone/Fax

Practice location:
  • Phone: 630-483-0665
  • Fax: 630-483-0526
Mailing address:
  • Phone: 630-483-0665
  • Fax: 630-483-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE EDUARDO MARTINEZ
Title or Position: PRESIDENT
Credential: M. D.
Phone: 630-483-0665