Healthcare Provider Details

I. General information

NPI: 1093623894
Provider Name (Legal Business Name): ERNESTO RAUL QUEVEDO ROJAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S ELLIS AVE
CHICAGO IL
60637-5418
US

IV. Provider business mailing address

5801 S ELLIS AVE
CHICAGO IL
60637-5418
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6505
  • Fax:
Mailing address:
  • Phone: 773-702-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number023688
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: