Provider Demographics
NPI:1407166648
Name:VALERIO, JOSE AMAURY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:AMAURY
Last Name:VALERIO
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 1:2642 N EMMETT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1512
Mailing Address - Country:US
Mailing Address - Phone:773-292-8300
Mailing Address - Fax:
Practice Address - Street 1:1044 N MOZART ST
Practice Address - Street 2:SUITE # 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2789
Practice Address - Country:US
Practice Address - Phone:773-292-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125056913207Q00000X
IL036129324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine