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Individual

DR. JOSE L. MEDINA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5015 N PAULINA ST, SUITE 325, CHICAGO, IL 60640-2756
(773) 775-7540
(773) 763-9792
Mailing address
5015 N PAULINA ST, SUITE 325, CHICAGO, IL 60640-2756
(773) 775-7540
(773) 763-9792

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
IL

Other

Enumeration date
09/24/2006
Last updated
07/08/2007
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