Provider Demographics
NPI:1356389035
Name:SOFIA GARCIA-BUDER, M.D., S.C.
Entity type:Organization
Organization Name:SOFIA GARCIA-BUDER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:GARCIA-BUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-388-5685
Mailing Address - Street 1:2719 N HALSTED ST
Mailing Address - Street 2:C-1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1413
Mailing Address - Country:US
Mailing Address - Phone:773-388-5685
Mailing Address - Fax:773-388-5687
Practice Address - Street 1:2719 N HALSTED ST
Practice Address - Street 2:C-1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1413
Practice Address - Country:US
Practice Address - Phone:773-388-5685
Practice Address - Fax:773-388-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074618207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074618Medicaid
IL01632690OtherBCBSI
IL4315864OtherCIGNA
ILE90491Medicare UPIN
IL01632690OtherBCBSI