Provider Demographics
NPI:1912934985
Name:ELIZONDO, JOSE FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FRANCISCO
Last Name:ELIZONDO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:70 W. HURON AVENUE
Mailing Address - Street 2:1708
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5345
Mailing Address - Country:US
Mailing Address - Phone:312-255-9327
Mailing Address - Fax:
Practice Address - Street 1:4600 N RAVENSWOOD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4510
Practice Address - Country:US
Practice Address - Phone:773-561-7500
Practice Address - Fax:773-561-7612
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036085068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE74329Medicare UPIN