Provider Demographics
NPI:1922258276
Name:VALVERDE, JUANITA (MD)
Entity Type:Individual
Prefix:PROF
First Name:JUANITA
Middle Name:
Last Name:VALVERDE
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 1:2525 N FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2611
Mailing Address - Country:US
Mailing Address - Phone:773-309-6740
Mailing Address - Fax:773-237-6606
Practice Address - Street 1:4849 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2503
Practice Address - Country:US
Practice Address - Phone:773-309-6740
Practice Address - Fax:773-237-6606
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074259Medicaid
IL036074259Medicaid