Individual
EZEQUIEL MENDEZ-HUERTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4121 S ARCHER AVE, CHICAGO, IL 60632
(773) 254-2525
(773) 254-7999
Mailing address
4121 S ARCHER AVE, CHICAGO, IL 60632
(773) 254-2525
(773) 254-7999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036089095
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089095
—
IL
Enumeration date
09/19/2006
Last updated
07/08/2007
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