Healthcare Provider Details

I. General information

NPI: 1144343658
Provider Name (Legal Business Name): LUIS M. SANCHEZ PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

8441 NEENAH AVE
BURBANK IL
60459-2345
US

V. Phone/Fax

Practice location:
  • Phone: 773-869-7488
  • Fax: 773-869-3578
Mailing address:
  • Phone: 708-430-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-000446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: