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Individual

DR. JOSE ANTONIO PENAHERRERA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1890 SILVER CROSS BLVD, SUITE 265, NEW LENOX, IL 60451-9524
(815) 727-4292
(815) 727-5395
Mailing address
1890 SILVER CROSS BLVD, SUITE 265, NEW LENOX, IL 60451-9524
(815) 727-4292
(815) 727-5395

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036095226
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9928146
BC/BS
IL
Enumeration date
02/25/2007
Last updated
08/28/2013
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