Provider Demographics
NPI:1568555951
Name:TANDEZ, CORNELIA YILLASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIA
Middle Name:YILLASAN
Last Name:TANDEZ
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 1:8248 BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-298-6153
Mailing Address - Fax:773-327-2764
Practice Address - Street 1:3000 N HALSTEAD
Practice Address - Street 2:SUITE 725
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-327-2760
Practice Address - Fax:773-327-2764
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F99842Medicare UPIN