Provider Demographics
NPI:1457430910
Name:ENCINAS, EDUARDO JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JORGE
Last Name:ENCINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JORGE
Other - Middle Name:EDUARDO
Other - Last Name:ENCINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6851 LOREL AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3426
Mailing Address - Country:US
Mailing Address - Phone:847-676-3729
Mailing Address - Fax:
Practice Address - Street 1:4608 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3251
Practice Address - Country:US
Practice Address - Phone:773-927-7574
Practice Address - Fax:773-927-7583
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060976207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600405OtherBLUE CROSS CICERO OFFC
IL363484385OtherTAX ID NO.
IL036060976Medicaid
IL01619327OtherBLUE CROSS NO ASHLAND OFC
IL31600405OtherBLUE CROSS CICERO OFFC
ILC47352Medicare UPIN