Healthcare Provider Details

I. General information

NPI: 1578052130
Provider Name (Legal Business Name): MARIA VERONICA AVENDANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 W 87TH ST
CHICAGO IL
60652-3937
US

IV. Provider business mailing address

2734 W 87TH ST
CHICAGO IL
60652-3937
US

V. Phone/Fax

Practice location:
  • Phone: 773-918-4700
  • Fax:
Mailing address:
  • Phone: 773-918-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036167241
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: