Healthcare Provider Details

I. General information

NPI: 1295753093
Provider Name (Legal Business Name): CARLOS ORTEGA MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE STE 780
CHICAGO IL
60625-7066
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE STE 780
CHICAGO IL
60625-7066
US

V. Phone/Fax

Practice location:
  • Phone: 773-235-8887
  • Fax: 773-235-8882
Mailing address:
  • Phone: 773-235-8887
  • Fax: 773-235-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036100042
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036100042
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036100042
License Number StateIL

VIII. Authorized Official

Name: DR. CARLOS D ORTEGA
Title or Position: EMPLOYEE
Credential: M.D.
Phone: 773-235-8887