Individual
JASON BALQUIEDRA LAMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE RM 3107, MAYWOOD, IL 60153-3328
(708) 216-9169
(708) 216-1249
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
125.079316
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2022
Last updated
05/18/2022
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