Healthcare Provider Details

I. General information

NPI: 1710160130
Provider Name (Legal Business Name): MUNOZ M.D. AND CVENGROS M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N SHERIDAN RD SUITE G2
CHICAGO IL
60657-6156
US

IV. Provider business mailing address

195 N HARBOR DR 4708
CHICAGO IL
60601-7514
US

V. Phone/Fax

Practice location:
  • Phone: 773-755-2600
  • Fax:
Mailing address:
  • Phone: 773-755-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TERESA CVENGROS
Title or Position: PHYSICIAN
Credential:
Phone: 773-755-2600