Provider Demographics
NPI:1790797066
Name:LINARES, OSCAR ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:ROBERTO
Last Name:LINARES
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 1:6545 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2313
Mailing Address - Country:US
Mailing Address - Phone:708-788-0077
Mailing Address - Fax:708-788-5620
Practice Address - Street 1:6545 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2313
Practice Address - Country:US
Practice Address - Phone:708-788-0077
Practice Address - Fax:708-788-5620
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087151Medicaid
IL036087151Medicaid
IL167377Medicare ID - Type Unspecified