Provider Demographics
NPI:1700019437
Name:RICARDO IZQUIERDO,M.D., P.C.
Entity Type:Organization
Organization Name:RICARDO IZQUIERDO,M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-794-0700
Mailing Address - Street 1:2425 W 22ND ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1245
Mailing Address - Country:US
Mailing Address - Phone:630-794-0700
Mailing Address - Fax:630-794-9550
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:SUITE 213
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1245
Practice Address - Country:US
Practice Address - Phone:630-794-0700
Practice Address - Fax:630-794-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-064192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty