Healthcare Provider Details

I. General information

NPI: 1871339721
Provider Name (Legal Business Name): CARLOS MURILLO-ZEPEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 EUCLID AVE
BERWYN IL
60402-3471
US

IV. Provider business mailing address

3231 EUCLID AVE
BERWYN IL
60402-3471
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-3401
  • Fax: 708-783-3341
Mailing address:
  • Phone: 708-783-3401
  • Fax: 708-783-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125083947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: