Individual
IVAN JOSE CUESTA ISABEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1775 DEMPSTER ST STE AIP, PARK RIDGE, IL 60068-1143
(847) 723-6790
(847) 723-6799
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-5734
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036156358
IL
208D00000X
General Practice Physician
MT209694
PA
Other
Enumeration date
07/20/2015
Last updated
12/14/2023
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