Provider Demographics
NPI:1164582680
Name:SOLER, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:SOLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7272
Mailing Address - Country:US
Mailing Address - Phone:773-235-7455
Mailing Address - Fax:773-235-7055
Practice Address - Street 1:2110 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7272
Practice Address - Country:US
Practice Address - Phone:773-235-7455
Practice Address - Fax:773-235-7055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36082596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36082596OtherSTATE LICENSE NUMBER
ILF11064Medicare UPIN