Provider Demographics
NPI:1487652129
Name:GALVEZ, JOSE MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
Last Name:GALVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-653-8406
Mailing Address - Fax:847-653-8429
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 145
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-653-8406
Practice Address - Fax:847-653-8429
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210601Medicare ID - Type Unspecified
ILK13309Medicare UPIN