Provider Demographics
NPI:1790830354
Name:JANUARIO P. ESTRADA, M.D., S.C.
Entity Type:Organization
Organization Name:JANUARIO P. ESTRADA, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANUARIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-844-3199
Mailing Address - Street 1:PO BOX 64568
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-4568
Mailing Address - Country:US
Mailing Address - Phone:630-288-6200
Mailing Address - Fax:855-781-4084
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:SUITE 306
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1090
Practice Address - Country:US
Practice Address - Phone:847-844-3199
Practice Address - Fax:847-844-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDE6577OtherRAILROAD MEDICARE PARTB
IL0021623344OtherBCBS PROVIDER ID
IL212408Medicare ID - Type UnspecifiedLOCALITY 16
IL0021623344OtherBCBS PROVIDER ID
IL212409Medicare ID - Type UnspecifiedLOCALITY 15
ILDE6577Medicare PIN
IL212409Medicare PIN