Provider Demographics
NPI:1184712887
Name:HERNANDEZ, ROSITA S (MD)
Entity type:Individual
Prefix:
First Name:ROSITA
Middle Name:S
Last Name:HERNANDEZ
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 1:800 S WELLS ST
Mailing Address - Street 2:UNIT 922
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4529
Mailing Address - Country:US
Mailing Address - Phone:312-913-0252
Mailing Address - Fax:
Practice Address - Street 1:6853 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1868
Practice Address - Country:US
Practice Address - Phone:773-873-7800
Practice Address - Fax:773-224-1337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14740Medicare UPIN