Healthcare Provider Details

I. General information

NPI: 1326939802
Provider Name (Legal Business Name): ESTEBAN ELIAS EMMANUEL RODRIGUEZ FERREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

441 W BARRY AVE APT 533
CHICAGO IL
60657-5526
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6730
  • Fax:
Mailing address:
  • Phone: 872-366-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.085314
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: