MEDICARE: LUZ DARY VALDES

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	173000000X	Legal Medicine		IL

General Provider Information

NPI Number	:	1245183342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ DARY VALDES

Provider Business Mailing Address
First Line	:	2201 N 72ND CT
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-2722
Country	:	US
Telephone Number	:	773-698-5645
Fax Number	:

Provider Business Practice Location Address
First Line	:	5719 W FULLERTON AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2337
Country	:	US
Telephone Number	:	773-865-2384
Fax Number	:

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

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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