Individual
DR. ELEANOR VIRAY BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1050 ESSINGTON RD STE C, JOLIET, IL 60435
(815) 514-2425
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036093764
IL
207R00000X
Internal Medicine Physician
ME0073938
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
834330
MEDICARE GROUP #
IL
Enumeration date
12/12/2005
Last updated
08/03/2023
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