Provider Demographics
NPI:1114552908
Name:BARAJAS, DORIS
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 W ADAMS ST CHICAGO, IL 60661
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661
Mailing Address - Country:US
Mailing Address - Phone:312-752-4466
Mailing Address - Fax:312-559-2968
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:3RD FL- SPECIAL CARE NURSERY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2332
Practice Address - Country:US
Practice Address - Phone:216-260-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily