M DOMINGUEZ JR MD SC (NPI# 1609056795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1609056795 |
Entity Type | Organization |
Organization Name | M DOMINGUEZ JR MD SC |
Practice Address |
1431 N Western Ave Suite 212 Chicago IL 60622-1797 |
Practice Telephone | 7737703409 |
Practice Fax Number | 7737703418 |
Mailing Telephone | 7737703409 |
Mailing Fax Number | 7737703418 |
Enumeration Date | 2007-11-06 |
Last Update Date | 2007-11-06 |
Authorized Official Name | DR. MANUEL GARCIA DOMINGUEZ JR. (PRESIDENT) |
Authorized Official Telephone | 7737703409 |
Authorized Official Credential | M.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
IL | Ambulatory Health Care Facilities |
Street Address |
1431 N WESTERN AVE SUITE 212 |
City | CHICAGO |
State | IL |
Zip Code | 60622-1797 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023017480 | Ada I Arias Md Sc | Internal Medicine | 1431 N Western Ave, Ste 133, Chicago, IL 60622-1797 | 2005-07-19 |
1609302900 | Clemen Gonzalez | Student in an Organized Health Care Education/Training Program | 1431 N Western Ave, Suite 406, Chicago, IL 60622-1797 | 2017-05-05 |
1205374964 | Primecare Community Health Inc | Clinic/Center | 1431 N Western Ave, Suite 401, Chicago, IL 60622-1797 | 2017-02-02 |
1336692359 | Primecare Community Health Inc. | Clinic/Center | 1431 N Western Ave, Suite 209, Chicago, IL 60622-1797 | 2016-07-26 |
1760835250 | Teresa Zasowski | Student in an Organized Health Care Education/Training Program | 1431 N Western Ave, Suite 406, Chicago, IL 60622-1797 | 2016-07-19 |
1376994723 | Angie Aybar | Family Medicine | 1431 N Western Ave, Suite 406, Chicago, IL 60622-1797 | 2016-06-28 |
1598111924 | Roger Alvarez Soto | Student in an Organized Health Care Education/Training Program | 1431 N Western Ave, Suite 406, Chicago, IL 60622-1797 | 2016-05-04 |
1558722074 | Andrea Kuebbeler | Social Worker | 1431 N Western Ave, Suite 406, Chicago, IL 60622-1797 | 2016-03-10 |
1548640675 | Iffath Hussain | Student in an Organized Health Care Education/Training Program | 1431 N Western Ave, Suite 406, Chicago, IL 60622-1797 | 2015-06-03 |
1982083176 | Patrick Porter | Physical Therapist | 1431 N Western Ave, Suite 510, Chicago, IL 60622-1797 | 2015-05-21 |
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1720620545 | Emily Claire Bonanno | Counselor | 1397 N Miwaukee Ave, Chicago, IL 60622 | 2019-10-14 |
1891342093 | Taylor Mallon | Speech-Language Pathologist | 8870 South Duffy Avenue, Apartment 406, Chicago, IL 60622 | 2019-08-22 |
1083260277 | Maggie Inman | Student in an Organized Health Care Education/Training Program | 1431 N Claremont Avenue, 2nd Floor Pavilion, Chicago, IL 60622 | 2019-08-13 |
1174176168 | Karol Maricel Quelal Analuisa | Internal Medicine | 1901 W Harrison, Chicago Il 60612-3714, Chicago, IL 60622 | 2019-07-19 |
1073076105 | Nichole Galullo | Social Worker | 1431 N Claremont 2nd Floor, Chicago, IL 60622 | 2019-04-06 |
1003375122 | Alfredo Delgado Perez Sr. | Psychologist | 1127 N Oakley Bvl 3 Floor, Chicago, IL 60622 | 2019-03-18 |
1841773439 | Abigail Hector | Counselor | 1521 N Milwaukee Ave, 3n, Chicago, IL 60622 | 2018-09-11 |
1164916144 | Dorothy Mitkowski | Student in an Organized Health Care Education/Training Program | 1127 N. Oakley Blvd., 2nd Floor, Chicago, IL 60622 | 2018-06-21 |
1255825121 | Kara Lynn Daniel | Speech-Language Pathologist | 1540 N Artesian Ave Apt 2r, Chicago, IL 60622 | 2018-06-14 |
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Taxonomy Code | 261QP2300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Primary Care |
Definition to come... |
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1366872061 | Lawndale Christian Health Center | Clinic/Center | 5122 S Archer Ave, Chicago, IL 60632-4508 | 2013-11-15 |
1083051643 | Oak Street Health Physicians Group, PC | Clinic/Center | 30 W Monroe St Ste 1200, Chicago, IL 60603-2420 | 2013-05-22 |
1043564529 | Triple S Medical Care S.c. | Clinic/Center | 6455 S Pulaski Rd, Chicago, IL 60629 | 2012-11-05 |
1548541022 | Valentinalb,s.c. | Clinic/Center | 5108 N Lincoln Ave, Chicago, IL 60625-7295 | 2011-08-29 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.