Healthcare Provider Details

I. General information

NPI: 1801473632
Provider Name (Legal Business Name): JUAN MACIAS GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TOWER CT STE A
GURNEE IL
60031-5711
US

IV. Provider business mailing address

600 S PAULINA ST STE 440
CHICAGO IL
60612-3806
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-3525
  • Fax:
Mailing address:
  • Phone: 312-942-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.170665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: