Provider Demographics
NPI:1376685636
Name:YUNEZ, SAMUEL MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MANUEL
Last Name:YUNEZ
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 1:7411 LAKE ST STE 2210
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1886
Mailing Address - Country:US
Mailing Address - Phone:708-450-0055
Mailing Address - Fax:708-450-0288
Practice Address - Street 1:7411 LAKE ST STE 2210
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1886
Practice Address - Country:US
Practice Address - Phone:708-450-0055
Practice Address - Fax:708-450-0288
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360757641Medicaid
IL0360757641Medicaid
ILL35592Medicare PIN