Provider Demographics
NPI:1508924614
Name:MONTENEGRO-YANEZA, HEDELITA S (MD)
Entity Type:Individual
Prefix:DR
First Name:HEDELITA
Middle Name:S
Last Name:MONTENEGRO-YANEZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639
Mailing Address - Country:US
Mailing Address - Phone:773-227-2040
Mailing Address - Fax:773-227-1210
Practice Address - Street 1:4039 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639
Practice Address - Country:US
Practice Address - Phone:773-227-2040
Practice Address - Fax:773-227-1210
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054607208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054607Medicaid
ILD14248Medicare UPIN