Provider Demographics
NPI:1972501096
Name:HERNANDEZ, MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HERNANDEZ
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 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4717
Mailing Address - Country:US
Mailing Address - Phone:847-214-5750
Mailing Address - Fax:847-214-5753
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4717
Practice Address - Country:US
Practice Address - Phone:847-214-5750
Practice Address - Fax:847-214-5753
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532170OtherBLUE CROSS BLUE SHIELD
IL036073467Medicaid
ILDB0387OtherRAILROAD MEDICARE GROUP
IL610033301OtherDOL WORKCOMP
ILP00096232OtherRAILROAD MEDICARE
IL036073467Medicaid
ILP00096232OtherRAILROAD MEDICARE
ILD16417Medicare UPIN