Provider Demographics
NPI:1356514434
Name:CORNELIA V. TANDEZ, M.D.,LTD
Entity type:Organization
Organization Name:CORNELIA V. TANDEZ, M.D.,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:VILLASAN
Authorized Official - Last Name:TANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-298-6153
Mailing Address - Street 1:3000 N HALSTED
Mailing Address - Street 2:ADVOCATE ILLINOIS MASONIC MEDICAL OFFICE CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-327-2760
Mailing Address - Fax:773-327-2764
Practice Address - Street 1:8248 W BALLARD RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1544
Practice Address - Country:US
Practice Address - Phone:773-327-2760
Practice Address - Fax:773-327-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center