Provider Demographics
NPI:1710564554
Name:IRIZARRY BERRIOS, EMANUEL IGNACIO (MD)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:IGNACIO
Last Name:IRIZARRY BERRIOS
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 1:1717 W CONGRESS PKWY FL 10
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3809
Mailing Address - Country:US
Mailing Address - Phone:312-942-4120
Mailing Address - Fax:312-942-5271
Practice Address - Street 1:1717 W CONGRESS PKWY FL 10
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3809
Practice Address - Country:US
Practice Address - Phone:312-942-4120
Practice Address - Fax:312-942-5271
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125081769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine