Provider Demographics
NPI:1922098920
Name:JAIMES-HUERTA, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:JAIMES-HUERTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:JAIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:151 DUNDEE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1648
Mailing Address - Country:US
Mailing Address - Phone:847-426-9396
Mailing Address - Fax:
Practice Address - Street 1:151 DUNDEE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1648
Practice Address - Country:US
Practice Address - Phone:847-426-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112618207Q00000X, 193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193400000XGroupSingle Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112618Medicaid
IL036112618OtherIL STATE LICENSE
ILK14836Medicare ID - Type Unspecified4TH SITE PROV NUMBER
ILK14835Medicare ID - Type UnspecifiedPRIMARY SITE PROV NUMBER
ILI25181Medicare UPIN
ILK14834Medicare ID - Type Unspecified2ND SITE PROV NUMBER
IL036112618Medicaid