Healthcare Provider Details

I. General information

NPI: 1689109704
Provider Name (Legal Business Name): J C REYES PEDIATRICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6745 W 63RD ST
CHICAGO IL
60638-4003
US

IV. Provider business mailing address

6745 W 63RD ST
CHICAGO IL
60638-4003
US

V. Phone/Fax

Practice location:
  • Phone: 773-229-2373
  • Fax: 773-229-2376
Mailing address:
  • Phone: 773-229-2373
  • Fax: 773-229-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036077248
License Number StateIL

VIII. Authorized Official

Name: DR. JOSELITO C REYES
Title or Position: PRESIDENT/C.E.O.
Credential: M.D.
Phone: 773-229-2373