Healthcare Provider Details

I. General information

NPI: 1730829979
Provider Name (Legal Business Name): MANUEL ALBERTO PAREDES FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/10/2023
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 95TH ST STE 200
OAK LAWN IL
60453-3072
US

IV. Provider business mailing address

4220 W 95TH ST STE 200
OAK LAWN IL
60453-3072
US

V. Phone/Fax

Practice location:
  • Phone: 708-398-0287
  • Fax: 708-684-2032
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.079642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: