Organization
HERNAN REYES MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERNAN REYES MD (DIRECTOR)
(708) 656-9247
Entity
Organization
Contact information
Practice address
5610 W CERMAK RD, UNIT #2, CICERO, IL 60804-2219
(708) 656-9247
(708) 656-9358
Mailing address
PO BOX 129, PLAINFIELD, IL 60544-0129
(800) 843-0355
(815) 834-1300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036117857
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01638280
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/20/2007
Last updated
04/28/2010
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