MEDICARE: DR. JUDRYN MIREYA RACINES 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	207R00000X	Internal Medicine Physician	FR0435669-068	NY

General Provider Information

NPI Number	:	1831403575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDRYN MIREYA RACINES MD

Provider Business Mailing Address
First Line	:	707 W WAVELAND AVE
Second Line	:	APT 1711
City	:	CHICAGO
State	:	IL
Zip	:	60613-4111
Country	:	US
Telephone Number	:	347-735-2835
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 FOREST AVE APT 3E
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2431
Country	:	US
Telephone Number	:	347-735-2835
Fax Number	:

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

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	01/24/2022

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