Individual
MARIA DOLORES HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-2212
Mailing address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-4251
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
MD-43064
IA
207VX0000X
Obstetrics Physician
MD-43064
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81101
TRAINING PERMIT
—
Enumeration date
04/22/2008
Last updated
08/24/2022
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