Provider Demographics
NPI:1013013374
Name:CRUZ, ANTONIO B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:B
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1601 TANGLEWOOD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133
Mailing Address - Country:US
Mailing Address - Phone:630-289-7800
Mailing Address - Fax:630-289-9187
Practice Address - Street 1:1601 TANGLEWOOD
Practice Address - Street 2:SUITE 106
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133
Practice Address - Country:US
Practice Address - Phone:630-289-7800
Practice Address - Fax:630-289-9187
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL636040977208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362715536OtherBCBS
IL036040977Medicaid
IL362715536OtherBCBS
D12147Medicare UPIN