1487652129 NPI number — DR. JOSE MIGUEL GALVEZ MD

Table of content: DR. JOSE MIGUEL GALVEZ MD (NPI 1487652129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487652129 NPI number — DR. JOSE MIGUEL GALVEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALVEZ
Provider First Name:
JOSE
Provider Middle Name:
MIGUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487652129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1875 DEMPSTER ST
Provider Second Line Business Mailing Address:
SUITE 145
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60068-1186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-653-8406
Provider Business Mailing Address Fax Number:
847-653-8429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1875 DEMPSTER ST
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068-1186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-653-8406
Provider Business Practice Location Address Fax Number:
847-653-8429
Provider Enumeration Date:
07/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)