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NPI Code Detail

MEDICARE: DR. ELBA-JULIE QUINONES M.D.

MEDICARE: DR. ELBA-JULIE QUINONES 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
1208000000XPediatrics Physician036-071562IL

General Provider Information

NPI Number : 1073615563
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELBA-JULIE QUINONES M.D.
Provider Business Mailing Address
First Line : 5240 N PULASKI RD
Second Line : SUITE E
City : CHICAGO
State : IL
Zip : 60630-1750
Country : US
Telephone Number : 773-463-7337
Fax Number : 773-478-5025
Provider Business Practice Location Address
First Line : 3600 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2319
Country : US
Telephone Number : 773-782-2800
Fax Number : 773-782-5042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2006
Last Update Date : 09/29/2020

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