Healthcare Provider Details

I. General information

NPI: 1407042591
Provider Name (Legal Business Name): MARIA L. REYES, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 S KOSTNER AVE SUITE 209
CHICAGO IL
60652-1126
US

IV. Provider business mailing address

7601 S KOSTNER AVE SUITE 209
CHICAGO IL
60652-1126
US

V. Phone/Fax

Practice location:
  • Phone: 773-585-5700
  • Fax: 773-585-5703
Mailing address:
  • Phone: 773-585-5700
  • Fax: 773-585-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MARIA L REYES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-585-5700