Provider Demographics
NPI:1164426094
Name:SANCHEZ, OSCAR MAURICIO (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:MAURICIO
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 BULL VALLEY RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7434
Mailing Address - Country:US
Mailing Address - Phone:815-578-0224
Mailing Address - Fax:815-578-0525
Practice Address - Street 1:5435 BULL VALLEY RD
Practice Address - Street 2:STE 218
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7435
Practice Address - Country:US
Practice Address - Phone:815-578-0224
Practice Address - Fax:815-578-0525
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095395207Q00000X
IL36095395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095395Medicaid
IL212957Medicare ID - Type UnspecifiedMEDICARE PART B
IL036095395Medicaid
IL212956Medicare ID - Type UnspecifiedMEDICARE PART B