Doctor Name: | DR. EDUARDO FERNANDES |
NPI Number: | 1023363934 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD, PHD |
License Number: | 125.062443 |
Business Practice Address: | 1740 W Taylor St Chicago, IL - 606127232 |
Business Phone Number: | 8666002273 |
Business Fax Number: | |
Mailing Address: | 903 S Ashland Ave, Apt 611 CHICAGO |
State: | IL |
Postal Code: | 606074002 |
Phone Number: | 3123940128 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2012 |
NPI Last Update Date: | 08/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 125.062443 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |