Provider Demographics
NPI:1952578304
Name:LA RAZA MEDICAL CENTER
Entity Type:Organization
Organization Name:LA RAZA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:ESPERANZA
Authorized Official - Last Name:URRUTIA-POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-238-2100
Mailing Address - Street 1:16 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2482
Mailing Address - Country:US
Mailing Address - Phone:630-238-2100
Mailing Address - Fax:630-238-2110
Practice Address - Street 1:16 E GREEN ST
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2482
Practice Address - Country:US
Practice Address - Phone:630-238-2100
Practice Address - Fax:630-238-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112375Medicaid
1447363890OtherNPI
ILI43779OtherUPIN
IL02233119OtherBC/BS
IL036112375Medicaid