Provider Demographics
NPI:1497823629
Name:CORTES, JOAQUIN U SR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:U
Last Name:CORTES
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:675 W NORTH AVE
Mailing Address - Street 2:STE 405
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1612
Mailing Address - Country:US
Mailing Address - Phone:708-338-9004
Mailing Address - Fax:708-338-9574
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:STE 405
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1612
Practice Address - Country:US
Practice Address - Phone:708-338-9004
Practice Address - Fax:708-338-9574
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14269Medicare UPIN