Provider Demographics
NPI:1104074749
Name:SIERRA FERNANDEZ, HERNAN (MD)
Entity type:Individual
Prefix:
First Name:HERNAN
Middle Name:
Last Name:SIERRA FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N GARLAND CT APT 1703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4768
Mailing Address - Country:US
Mailing Address - Phone:312-810-4065
Mailing Address - Fax:
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:CSB 1262, M/C 856
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-355-3282
Practice Address - Fax:312-355-5548
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1054352080N0001X
IL036-1203142080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine