Provider Demographics
NPI:1508805029
Name:REYES, MARIA CONCEPCION (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CONCEPCION
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1300 W BELMONT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:773-975-8900
Mailing Address - Fax:773-975-8901
Practice Address - Street 1:1300 W BELMONT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:773-975-8900
Practice Address - Fax:773-975-8901
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG43872Medicare UPIN
ILL57082Medicare ID - Type Unspecified