Provider Demographics
NPI:1760480362
Name:FERNANDEZ, LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:FERNANDEZ
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 1:6101 N SHERIDAN RD
Mailing Address - Street 2:SUITE 19A EAST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2870
Mailing Address - Country:US
Mailing Address - Phone:773-852-4331
Mailing Address - Fax:
Practice Address - Street 1:6101 N SHERIDAN RD
Practice Address - Street 2:SUITE 19A EAST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2870
Practice Address - Country:US
Practice Address - Phone:773-852-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089058Medicaid
IL203583Medicare PIN
ILF90323Medicare UPIN