Provider Demographics
NPI:1356316855
Name:GARCIA-VALENZUELA, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:GARCIA-VALENZUELA
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 1:8901 W. GOLF ROAD
Mailing Address - Street 2:206
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6850
Mailing Address - Country:US
Mailing Address - Phone:847-699-0006
Mailing Address - Fax:847-699-1744
Practice Address - Street 1:8901 W. GOLF ROAD
Practice Address - Street 2:206
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-699-0006
Practice Address - Fax:847-699-1744
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113179207W00000X
IL036113179207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113179Medicaid
IL036113179Medicaid
H48317Medicare UPIN