Provider Demographics
NPI:1508884602
Name:REYES, PEDRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 N MIWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630
Mailing Address - Country:US
Mailing Address - Phone:773-205-8200
Mailing Address - Fax:773-205-1222
Practice Address - Street 1:4438 N MIWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630
Practice Address - Country:US
Practice Address - Phone:773-205-8200
Practice Address - Fax:773-205-1222
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364376595OtherCOMMERCIAL
IL71640223OtherBCBS-PPO
IL036103291Medicaid
IL1508884602OtherNPI
IL71640223OtherBCBS-PPO