Provider Demographics
NPI:1174840706
Name:REALIZA, IRMA F (MD)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:F
Last Name:REALIZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7250 N CICERO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1643
Mailing Address - Country:US
Mailing Address - Phone:847-673-2877
Mailing Address - Fax:847-673-2989
Practice Address - Street 1:7250 N CICERO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1643
Practice Address - Country:US
Practice Address - Phone:847-673-2877
Practice Address - Fax:847-673-2989
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL03654724208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice