Healthcare Provider Details

I. General information

NPI: 1740231810
Provider Name (Legal Business Name): JOHN D ORTEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 4180
ELMHURST IL
60126-5630
US

IV. Provider business mailing address

4201 WINFIELD RD FL 4
WARRENVILLE IL
60555-4025
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9004
  • Fax: 331-221-3998
Mailing address:
  • Phone: 331-221-6377
  • Fax: 331-221-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number036102985
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036102985
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: