Individual
DR. JUAN C HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 S HENNEPIN AVE, DIXON, IL 61021
(815) 288-7711
(815) 285-8922
Mailing address
102 S. HENNEPIN AVE., DIXON, IL 61021
(815) 288-7711
(815) 285-8922
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-112949
IL
207Q00000X
Family Medicine Physician
Primary
036-112949
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112949
—
IL
01
—
800200003
MEDICARE-KATHERINE SHAW BETHEA HOSPITAL
IL
01
—
K16904
MEDICARE-KSB MEDICAL GROUP
IL
Enumeration date
02/24/2006
Last updated
08/22/2018
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