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General NPI Number Information
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NPI Number | 1386868826
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Entity Type | Individual
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Provider Name | HERNAN REYES MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 5610 W CERMAK RD UNIT #2
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City | CICERO
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State | IL
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Zip | 60804-2219
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Country | US
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Telephone | 708-656-9247
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Fax | 708-656-9358
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | PLAINFIELD
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State | IL
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Zip | 60544-0129
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Country | US
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Telephone | 800-843-0355
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Fax | 815-834-1307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036117857
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License Number State | IL
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