MEDICARE: DR. JORGE DELATORRE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	036056756	IL
2	2085N0700X	Neuroradiology Physician	036056756	IL
3	2085N0904X	Nuclear Radiology Physician	036056756	IL
4	2085P0229X	Pediatric Radiology Physician	036056756	IL
5	2085R0202X	Diagnostic Radiology Physician	036056756	IL
6	2085R0204X	Vascular & Interventional Radiology Physician	036056756	IL
7	2085U0001X	Diagnostic Ultrasound Physician	036056756	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001619902	OTHER	IL	BLUE CROSS BLUE SHIELD-IL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063435923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE DELATORRE M.D.

Provider Business Mailing Address
First Line	:	3058 N AUSTIN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5126
Country	:	US
Telephone Number	:	773-637-6031
Fax Number	:	773-637-6031

Provider Business Practice Location Address
First Line	:	3058 N AUSTIN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5126
Country	:	US
Telephone Number	:	773-637-6031
Fax Number	:	773-637-6031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/26/2026

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Directions to “ DR. JORGE DELATORRE M.D.” Practice Location

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