Provider Demographics
NPI:1275508251
Name:CRUZ, SIDNEY R (MD)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:R
Last Name:CRUZ
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 1:5300 WEST DEVON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4108
Mailing Address - Country:US
Mailing Address - Phone:773-631-2223
Mailing Address - Fax:773-631-5607
Practice Address - Street 1:5300 WEST DEVON AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4108
Practice Address - Country:US
Practice Address - Phone:773-631-2223
Practice Address - Fax:773-631-5607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12429Medicare UPIN
ILCR465770Medicare ID - Type Unspecified