Individual
DR. BESSIE SMITHERS DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5159 W FULLERTON AVE, CHICAGO, IL 60639-2403
(773) 637-6623
(773) 637-6622
Mailing address
5159 W. FULLERTON AVENUE, CHICAGO, IL 60639-2408
(773) 637-6622
(773) 637-6622
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036058438
IL
208D00000X
General Practice Physician
Primary
036-058438
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000516
UNICARE PN
IL
01
—
0100289
UHC PN
IL
05
—
036058438
—
IL
01
—
156321253824
HUMANA PN
IL
01
—
316-01173
BC/BC PN
IL
Enumeration date
08/19/2006
Last updated
01/20/2009
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