Individual
EDGAR MANUEL REYNOSO VANDERHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612
(866) 600-2273
Mailing address
1740 W TAYLOR ST,, CHICAGO, IL 60612
(866) 600-2273
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
036170881
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/04/2021
Last updated
09/24/2024
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