Healthcare Provider Details

I. General information

NPI: 1811334626
Provider Name (Legal Business Name): YESENIA ARCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR ST STE 101
MELROSE PARK IL
60160-4100
US

IV. Provider business mailing address

3231 S. EUCLID AVENUE 5TH FLOOR
BERWYN IL
60402
US

V. Phone/Fax

Practice location:
  • Phone: 708-406-3040
  • Fax:
Mailing address:
  • Phone: 708-783-2000
  • Fax: 708-783-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125062653
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: