Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036133691 | IL |
N | 2084N0400X | Neurologist | 125-057209 | IL |
NPI | 1003142704 |
---|---|
Provider Name | Dr. Antonio Hernando Iglesias |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2009 |
Last Update Date | 12/04/2021 |