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General NPI Number Information
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NPI Number | 1356506307
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Entity Type | Organization
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Legal Business Name | ANTONIO B. CRUZ M.D.S.C.
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 1601 TANGLEWOOD AVE STE 106
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City | HANOVER PARK
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State | IL
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Zip | 60133-3381
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Country | US
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Telephone | 630-289-7800
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Fax | 630-289-9187
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Provider Business Mailing Address
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Address Line | 1601 TANGLEWOOD AVE STE 106
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City | HANOVER PARK
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State | IL
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Zip | 60133-3381
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Country | US
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Telephone | 630-289-7800
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Fax | 630-289-9187
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTONIO B. CRUZ
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Credential | M.D.
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Telephone | 630-289-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 3640977
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License Number State | IL
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