1023683513 NPI number — CORNELIA V. TANDEZ,MD,LTD

Table of content: (NPI 1023683513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023683513 NPI number — CORNELIA V. TANDEZ,MD,LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNELIA V. TANDEZ,MD,LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1023683513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8248 W BALLARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60714-1544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-962-0149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
637 E GOLF RD STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON HTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-4070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-258-5098
Provider Business Practice Location Address Fax Number:
847-258-5061
Provider Enumeration Date:
05/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TANDEZ
Authorized Official First Name:
CORNELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-962-0149

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036086199 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com