Provider Demographics
NPI:1154400513
Name:BAUTISTA, MARIA RIZA DE GUZMAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA RIZA
Middle Name:DE GUZMAN
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6249 N KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5109
Mailing Address - Country:US
Mailing Address - Phone:773-875-7396
Mailing Address - Fax:
Practice Address - Street 1:6307 S STEWART AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-487-5224
Practice Address - Fax:773-487-7240
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164641Medicare UPIN