Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036077248 | IL |
N | 2080N0001X | Neonatal-Perinatal Doctor | 036-077248 | IL |
NPI | 1134120389 |
---|---|
Provider Name | Dr. Joselito C Reyes |
First Address | Chicago, IL 60638-2419 |
Second Address | Chicago, IL 60638-2419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-077248-2 | (05) | IL |