Provider Demographics
NPI:1639445877
Name:RIVAS, JOSEPH R (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:RIVAS
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W BELMONT AVE
Mailing Address - Street 2:#32
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4663
Mailing Address - Country:US
Mailing Address - Phone:630-881-1148
Mailing Address - Fax:
Practice Address - Street 1:511 W BELMONT AVE
Practice Address - Street 2:#32
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4663
Practice Address - Country:US
Practice Address - Phone:630-881-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43254207T00000X
LAMD.09654R207T00000X
PR8113207T00000X
NY141769207T00000X
PAMD 028112 E207T00000X
ZZ86/0431207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery