Provider Demographics
NPI:1366419194
Name:HERNANDEZ, HEBERTO Z (MD)
Entity type:Individual
Prefix:DR
First Name:HEBERTO
Middle Name:Z
Last Name:HERNANDEZ
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 1:1954 1ST ST STE 335
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3104
Mailing Address - Country:US
Mailing Address - Phone:847-433-5864
Mailing Address - Fax:
Practice Address - Street 1:1780 GREEN BAY RD STE 202
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3276
Practice Address - Country:US
Practice Address - Phone:847-433-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH77635Medicare UPIN