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Organization
SANITAS MEDICAL GROUP SC
Active
Organization
SANITAS MEDICAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE ANTONIO PENAHERRERA M.D. (PRESIDENT)
(815) 727-4292
Entity
Organization
Contact information
Practice address
1301 COPPERFIELD AVE, SUITE 203, JOLIET, IL 60432-2056
(815) 727-4292
(815) 727-5395
Mailing address
1301 COPPERFIELD AVE, SUITE 203, JOLIET, IL 60432-2056
(815) 727-4292
(815) 727-5395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9928146
BC/BS
IL
Enumeration date
05/11/2007
Last updated
01/05/2012
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