MEDICARE: DR. JORGE J PRIETO 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	174400000X	Specialist	36058076	IL
2	207X00000X	Orthopaedic Surgery Physician	36058076	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1627223	OTHER	IL	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740273747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE J PRIETO M.D.

Provider Business Mailing Address
First Line	:	800 AUSTIN ST
Second Line	:	EAST TOWER STE 254
City	:	EVANSTON
State	:	IL
Zip	:	60202-3439
Country	:	US
Telephone Number	:	847-475-4550
Fax Number	:	847-475-0482

Provider Business Practice Location Address
First Line	:	800 AUSTIN ST
Second Line	:	#254
City	:	EVANSTON
State	:	IL
Zip	:	60202-3439
Country	:	US
Telephone Number	:	847-475-4550
Fax Number	:	847-475-0482

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	04/28/2021

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