Provider Demographics
NPI:1740334663
Name:CRUZ, PEDRO CARLOS A (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO CARLOS
Middle Name:A
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:756 BUCKINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4307
Mailing Address - Country:US
Mailing Address - Phone:630-213-5878
Mailing Address - Fax:
Practice Address - Street 1:650 E. PHOENIX CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-225-9900
Practice Address - Fax:708-225-9997
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF57311Medicare UPIN