Healthcare Provider Details

I. General information

NPI: 1417535469
Provider Name (Legal Business Name): LAURA ILEANA FERNANDEZ MORALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA ILEANA FERNANDEZ MD

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE STE 1304
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-6686
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2700
  • Fax: 847-570-2822
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036172047
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125081019
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: