Healthcare Provider Details

I. General information

NPI: 1205019270
Provider Name (Legal Business Name): ERNESTO CABRERA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE SUITE 202
CHICAGO IL
60622
US

IV. Provider business mailing address

1431 N WESTERN AVE SUITE 202
CHICAGO IL
60622
US

V. Phone/Fax

Practice location:
  • Phone: 773-489-6605
  • Fax: 312-633-5863
Mailing address:
  • Phone: 773-489-6605
  • Fax: 312-633-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARISSA SAYSON FERNANDEZ
Title or Position: MEDICAL ASSISTANT
Credential: MEDICAL ASSISTANT
Phone: 773-489-6605