Provider Demographics
NPI:1497956981
Name:AYALA, JUANBOSCO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANBOSCO
Middle Name:
Last Name:AYALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10604 SOUTHWEST HIGHWAY
Mailing Address - Street 2:STE 107
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2717
Mailing Address - Country:US
Mailing Address - Phone:708-422-0636
Mailing Address - Fax:708-424-2164
Practice Address - Street 1:10604 SOUTHWEST HIGHWAY
Practice Address - Street 2:STE 107
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2717
Practice Address - Country:US
Practice Address - Phone:708-422-0636
Practice Address - Fax:708-424-2164
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2018-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.117517207R00000X
IL036117517207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine