Provider Demographics
NPI:1265479158
Name:MANUEL CESAR IGLESIAS, M.D., S.C.
Entity Type:Organization
Organization Name:MANUEL CESAR IGLESIAS, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-967-1149
Mailing Address - Street 1:8135 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2828
Mailing Address - Country:US
Mailing Address - Phone:847-967-1149
Mailing Address - Fax:847-967-8594
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 409
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-681-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21607825OtherBLUE SHIELD OF ILLINOIS
IL498180Medicare PIN
IL21607825OtherBLUE SHIELD OF ILLINOIS