Healthcare Provider Details

I. General information

NPI: 1871892448
Provider Name (Legal Business Name): DAVID GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER GME OFFICE 101/1740
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER GME OFFICE 101/1740
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-327-4463
  • Fax: 708-216-9033
Mailing address:
  • Phone: 708-327-4463
  • Fax: 708-216-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036133832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: