Provider Demographics
NPI:1558436329
Name:VERA, ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:VERA
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 1:2814 N. MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7272
Mailing Address - Country:US
Mailing Address - Phone:773-216-8372
Mailing Address - Fax:773-276-0333
Practice Address - Street 1:855 E GOLF RD
Practice Address - Street 2:STE 2133
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5222
Practice Address - Country:US
Practice Address - Phone:847-290-9122
Practice Address - Fax:847-290-9133
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36057483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15804Medicare UPIN