Healthcare Provider Details

I. General information

NPI: 1457346355
Provider Name (Legal Business Name): JOHN PAUL CUEVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10448 S PULASKI RD STE 1
OAK LAWN IL
60453-4895
US

IV. Provider business mailing address

10448 S PULASKI RD STE 1
OAK LAWN IL
60453-4895
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-7000
  • Fax: 708-346-6180
Mailing address:
  • Phone: 708-346-7000
  • Fax: 708-346-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036085818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: