Individual
DR. JORGE J PRIETO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 AUSTIN ST, #254, EVANSTON, IL 60202-3439
(847) 475-4550
(847) 475-0482
Mailing address
800 AUSTIN ST, EAST TOWER STE 254, EVANSTON, IL 60202-3439
(847) 475-4550
(847) 475-0482
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36058076
IL
207X00000X
Orthopaedic Surgery Physician
Primary
36058076
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1627223
BLUE SHIELD
IL
05
—
36058076
—
IL
Enumeration date
08/24/2005
Last updated
04/28/2021
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