Provider Demographics
NPI:1720492572
Name:MEDINA, VICTOR MANUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:MEDINA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:10370 HALIGUS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9582
Mailing Address - Country:US
Mailing Address - Phone:847-802-7480
Mailing Address - Fax:847-802-7485
Practice Address - Street 1:4305 W MEDICAL CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8425
Practice Address - Country:US
Practice Address - Phone:815-759-8100
Practice Address - Fax:815-759-8106
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2022-03-01
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Provider Licenses
StateLicense IDTaxonomies
IL036152203207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology