Healthcare Provider Details

I. General information

NPI: 1912695800
Provider Name (Legal Business Name): JESUS ANTONIO GALINDO CASTANEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MEDICAL CENTER DRIVE
MCHENRY IL
60050
US

IV. Provider business mailing address

4201 MEDICAL CENTER DRIVE
MCHENRY IL
60050
US

V. Phone/Fax

Practice location:
  • Phone: 619-636-6992
  • Fax:
Mailing address:
  • Phone: 619-636-6992
  • Fax:

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.083033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: