Provider Demographics
NPI:1750492401
Name:ORBETA, GREGORIO REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:REYES
Last Name:ORBETA
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 1:901 HAMPTON CRSE
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5812
Mailing Address - Country:US
Mailing Address - Phone:630-231-6607
Mailing Address - Fax:
Practice Address - Street 1:901 HAMPTON CRSE
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5812
Practice Address - Country:US
Practice Address - Phone:630-231-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044699174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL314130Medicare ID - Type Unspecified
ILD10993Medicare UPIN