Healthcare Provider Details

I. General information

NPI: 1285641613
Provider Name (Legal Business Name): JUDITH ANNETTE GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BUSCH PKWY SUITE 130
BUFFALO GROVE IL
60089-4541
US

IV. Provider business mailing address

1450 BUSCH PKWY SUITE 130
BUFFALO GROVE IL
60089-4541
US

V. Phone/Fax

Practice location:
  • Phone: 847-499-3070
  • Fax: 847-499-3079
Mailing address:
  • Phone: 847-499-3070
  • Fax: 847-499-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036071154
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: