Provider Demographics
NPI:1114904471
Name:PARADA, JORGE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:PARADA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:MCGANN
Other - Last Name:PAIVA PARADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:(LUH-NORTH ENT., RM. 7604)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-3232
Mailing Address - Fax:708-216-1259
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(LUH-NORTH ENT., RM. 7604)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-3232
Practice Address - Fax:708-216-1259
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36096125207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36096125Medicaid
IL550460Medicare ID - Type Unspecified
H01326Medicare UPIN