Provider Demographics
NPI:1558348722
Name:QUEJADA, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:QUEJADA
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 1:120 SPALDING DR
Mailing Address - Street 2:STE 111
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6766
Mailing Address - Country:US
Mailing Address - Phone:630-527-3788
Mailing Address - Fax:630-646-6071
Practice Address - Street 1:120 SPALDING DRIVE
Practice Address - Street 2:SUITE 111
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6766
Practice Address - Country:US
Practice Address - Phone:630-527-3788
Practice Address - Fax:630-646-6071
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36100626207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100626 2Medicaid
H62713Medicare UPIN
ILP00405026Medicare PIN
IL036100626 2Medicaid
ILK37283Medicare PIN
ILK36639Medicare PIN