Provider Demographics
NPI:1285641613
Name:GARCIA, JUDITH ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNETTE
Last Name:GARCIA
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 1:1450 BUSCH PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4541
Mailing Address - Country:US
Mailing Address - Phone:847-499-3070
Mailing Address - Fax:847-499-3079
Practice Address - Street 1:1450 BUSCH PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4541
Practice Address - Country:US
Practice Address - Phone:847-499-3070
Practice Address - Fax:847-499-3079
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics