M DOMINGUEZ JR MD SC NPI 1609056795

NPI Information

  • NPI: 1609056795
  • Provider Name: M DOMINGUEZ JR MD SC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Address: 1431 N WESTERN AVE
    SUITE 212
    CHICAGO, IL
    ZIP 60622
  • Phone: (773) 770-3409

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NPI Details

M DOMINGUEZ JR MD SC is a primary care clinic center in Chicago, IL. M DOMINGUEZ JR MD SC NPI is 1609056795. The provider is registered as an organization entity type.

The provider's business location address is:

1431 N WESTERN AVE
SUITE 212
CHICAGO, IL
ZIP 60622-797
Phone: (773) 770-3409
Fax: (773) 770-3418

The provider's authorized official is Manuel Garcia Dominguez .
The authorized official title is President and has the following contact phone number (773) 770-3409.

The enumeration date for this NPI number is 11/6/2007 and was last updated on 11/6/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1208970MEDICARE PINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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