Provider Demographics
NPI:1891753588
Name:MACIAS HUERTA, CARMEN PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:PATRICIA
Last Name:MACIAS HUERTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3532
Mailing Address - Country:US
Mailing Address - Phone:773-293-4362
Mailing Address - Fax:847-763-8937
Practice Address - Street 1:2740 W FOSTER AVE STE 412
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3532
Practice Address - Country:US
Practice Address - Phone:773-293-4362
Practice Address - Fax:847-763-8937
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085331207R00000X, 207RC0200X, 207RP1001X
IL036-085331207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215074OtherBLUE SHIELD PROVIDER NUMB
IL036085331Medicaid
IL036085331Medicaid
ILG20699Medicare UPIN