Individual
DR. JOSE RAFAEL DEURRUTIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3700 W 26TH ST, CHICAGO, IL 60623-3824
(773) 542-5203
Mailing address
3700 W 26TH ST, CHICAGO, IL 60623-3824
(773) 542-5203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.077752
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077752
—
IL
01
—
4622394
BLUE CROSS
—
Enumeration date
06/01/2006
Last updated
11/10/2020
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