Provider Demographics
NPI:1437125648
Name:PEDRERA, CARLOS FRANK (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:FRANK
Last Name:PEDRERA
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 1:1431 N WESTERN AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1774
Mailing Address - Country:US
Mailing Address - Phone:773-278-2600
Mailing Address - Fax:773-278-2424
Practice Address - Street 1:1431 N WESTERN AVE STE 502
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1774
Practice Address - Country:US
Practice Address - Phone:773-278-2600
Practice Address - Fax:773-278-2424
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051754Medicaid
C44229Medicare UPIN
K51787Medicare PIN