Individual
ANTHONY M FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7409 WOODRIDGE DR, WOODRIDGE, IL 60517-2249
(630) 241-1000
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036109979
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036109979
—
IL
01
—
P00714801
RR MEDICARE
IL
Enumeration date
10/19/2006
Last updated
01/20/2011
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