Provider Demographics
NPI:1801398607
Name:BAEZ, JUAN FABIEN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:FABIEN
Last Name:BAEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 E WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2627
Mailing Address - Country:US
Mailing Address - Phone:630-205-2821
Mailing Address - Fax:
Practice Address - Street 1:100 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4402
Practice Address - Country:US
Practice Address - Phone:309-438-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer