Organization
M DOMINGUEZ JR MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUEL GARCIA DOMINGUEZ JR. M.D. (PRESIDENT)
(773) 770-3409
Entity
Organization
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, SUITE 212, CHICAGO, IL 60622-1797
(773) 770-3409
(773) 770-3418
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
IL
Other
Enumeration date
11/06/2007
Last updated
11/06/2007
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