Healthcare Provider Details

I. General information

NPI: 1073615563
Provider Name (Legal Business Name): ELBA-JULIE QUINONES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W FULLERTON AVE
CHICAGO IL
60647-2319
US

IV. Provider business mailing address

5240 N PULASKI RD SUITE E
CHICAGO IL
60630-1750
US

V. Phone/Fax

Practice location:
  • Phone: 773-782-2800
  • Fax: 773-782-5042
Mailing address:
  • Phone: 773-463-7337
  • Fax: 773-478-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-071562
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: