Provider Demographics
NPI:1689109704
Name:J C REYES PEDIATRICS SC
Entity Type:Organization
Organization Name:J C REYES PEDIATRICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSELITO
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-229-2373
Mailing Address - Street 1:7000 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2202
Mailing Address - Country:US
Mailing Address - Phone:773-229-2373
Mailing Address - Fax:773-229-2376
Practice Address - Street 1:7000 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2202
Practice Address - Country:US
Practice Address - Phone:773-229-2373
Practice Address - Fax:773-229-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077248208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty