Healthcare Provider Details

I. General information

NPI: 1841556867
Provider Name (Legal Business Name): CLAUDIA SANCHEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 W FULLERTON AVE
CHICAGO IL
60647-2228
US

IV. Provider business mailing address

1431 N WESTERN AVE SUITE 401
CHICAGO IL
60622-1797
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-2229
  • Fax: 773-276-2190
Mailing address:
  • Phone: 312-572-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-138907
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: