Provider Demographics
NPI:1477835460
Name:LEMA JOFRE, ANTONIO J (QMHP)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:J
Last Name:LEMA JOFRE
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 N SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3734
Mailing Address - Country:US
Mailing Address - Phone:312-770-3624
Mailing Address - Fax:312-770-2557
Practice Address - Street 1:1127 N OAKLEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
Practice Address - Country:US
Practice Address - Phone:312-770-3624
Practice Address - Fax:312-770-2557
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator