Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036098896 | IL |
NPI | 1245219963 |
---|---|
Provider Name | Dr. John J. Fernandez |
First Address | Westchester, IL 60154-5701 |
Second Address | Chicago, IL 60612-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 18/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1633878 | BCBS (01) | IL |
207067 | MEDICARE PTAN LOCALITY 16 (01) | IL |
207073 | MEDICARE PTAN LOCALITY 15 (01) | IL |
5508638 | AETNA (01) | |
DA4902 | RAILROAD MEDICARE PTAN (01) | |
G16167 | (02) | |
P00132991 | RAILROAD MEDICARE (01) |