MEDICARE: LUIS L RIVERA 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	207Q00000X	Family Medicine Physician	036141783	IL

General Provider Information

NPI Number	:	1619396371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS L RIVERA M.D.

Provider Business Mailing Address
First Line	:	1713 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2014
Country	:	US
Telephone Number	:	312-413-4179
Fax Number	:	312-413-4188

Provider Business Practice Location Address
First Line	:	1713 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2014
Country	:	US
Telephone Number	:	312-413-4179
Fax Number	:	312-413-4188

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	02/11/2025

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Directions to “ LUIS L RIVERA M.D.” Practice Location

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