Provider Demographics
NPI:1477324754
Name:CRUZ, LUIS EDUARDO (PA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:EDUARDO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 APPLETREE ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3901
Mailing Address - Country:US
Mailing Address - Phone:630-618-0491
Mailing Address - Fax:
Practice Address - Street 1:440 LAKE COOK RD STE 2
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5263
Practice Address - Country:US
Practice Address - Phone:847-236-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical