Provider Demographics
NPI:1881698280
Name:QUINTERO, LOUIS (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 BROADWAY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2818
Mailing Address - Country:US
Mailing Address - Phone:217-224-6423
Mailing Address - Fax:217-223-3641
Practice Address - Street 1:927 BROADWAY ST STE 106
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2728
Practice Address - Country:US
Practice Address - Phone:217-224-6423
Practice Address - Fax:217-223-3641
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104740174400000X
IL036063637207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC34979Medicare UPIN
IL211041002Medicare PIN
IL211041002Medicare PIN