Organization Name: | ANTONIO B. CRUZ M.D.S.C. |
NPI Number: | 1356506307 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANTONIO B. CRUZ (PRESIDENT) |
Mailing Address: | 1601 Tanglewood Ave Ste 106 Hanover Park |
State: | IL US |
Postal Code: | 601333381 |
Phone Number: | 6302897800 |
Fax Number: | 6302899187 |
NPI Enumeration Date: | 07/18/2008 |
NPI Last Update Date: | 10/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 3640977 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |