Provider Demographics
NPI:1891809653
Name:QUINTERO, EDGAR ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ANTONIO
Last Name:QUINTERO
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 1:100 SPALDING DR
Mailing Address - Street 2:#204
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-357-8555
Mailing Address - Fax:630-357-0523
Practice Address - Street 1:100 SPALDING DR
Practice Address - Street 2:#204
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-357-8555
Practice Address - Fax:630-357-0523
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
21604845OtherBCBS
IL244260Medicare ID - Type Unspecified
D16566Medicare UPIN