MEDICARE: DR. LUCIANO NIMEDEZ VALDEZ 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	208000000X	Pediatrics Physician	36047130	IL

General Provider Information

NPI Number	:	1952310229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIANO NIMEDEZ VALDEZ M.D

Provider Business Mailing Address
First Line	:	6441 S PULASKI RD
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60629-5148
Country	:	US
Telephone Number	:	773-585-0808
Fax Number	:	773-582-8171

Provider Business Practice Location Address
First Line	:	6441 S PULASKI RD
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60629-5148
Country	:	US
Telephone Number	:	773-585-0808
Fax Number	:	773-582-8171

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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