MEDICARE: VICTORIA L HERNANDEZ MD

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	208000000X	Pediatrics Physician	036066374	IL

General Provider Information

NPI Number	:	1275629412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA L HERNANDEZ MD

Provider Business Mailing Address
First Line	:	2525 S MICHIGAN AVE
Second Line	:	ATT: MEDICAL STAFF OFFICE
City	:	CHICAGO
State	:	IL
Zip	:	60616-2315
Country	:	US
Telephone Number	:	312-567-7924
Fax Number	:	312-567-6189

Provider Business Practice Location Address
First Line	:	47 W POLK ST
Second Line	:	SUITE G1
City	:	CHICAGO
State	:	IL
Zip	:	60605-2000
Country	:	US
Telephone Number	:	312-922-3011
Fax Number	:	312-922-5860

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/14/2016

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