Individual
MR. SAMUEL MAURICIO CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1259 RICKERT DR STE 101, NAPERVILLE, IL 60540-8904
(630) 355-1300
(630) 355-3273
Mailing address
4300 COMMERCE CT, SUITE 230, LISLE, IL 60532-3698
(630) 968-1881
(630) 968-1719
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002213
IL
363AS0400X
Surgical Physician Assistant
85002213
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085002213
—
IL
01
—
970023229
RAILROAD MEDICARE
IL
Enumeration date
10/11/2006
Last updated
12/13/2012
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