Provider Demographics
NPI:1407042591
Name:MARIA L. REYES, M.D., S.C.
Entity Type:Organization
Organization Name:MARIA L. REYES, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-585-5700
Mailing Address - Street 1:7601 S KOSTNER AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1126
Mailing Address - Country:US
Mailing Address - Phone:773-585-5700
Mailing Address - Fax:773-585-5703
Practice Address - Street 1:7601 S KOSTNER AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1126
Practice Address - Country:US
Practice Address - Phone:773-585-5700
Practice Address - Fax:773-585-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty