Individual
DR. MANUEL GARCIA DOMINGUEZ JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1431 N WESTERN AVE, SUITE 212, CHICAGO, IL 60622-1797
(773) 770-3409
(773) 770-3418
Mailing address
1431 N WESTERN AVE, STE 201, CHICAGO, IL 60622-7712
(773) 661-1285
(773) 904-8129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036087595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634263
BLUE CROSS BLUE SHIELD
IL
05
—
036087595
—
IL
Enumeration date
01/27/2007
Last updated
07/24/2018
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