Provider Demographics
NPI:1386868826
Name:REYES, HERNAN (MD)
Entity type:Individual
Prefix:
First Name:HERNAN
Middle Name:
Last Name:REYES
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0129
Mailing Address - Country:US
Mailing Address - Phone:800-843-0355
Mailing Address - Fax:815-834-1307
Practice Address - Street 1:5610 W CERMAK RD
Practice Address - Street 2:UNIT #2
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2219
Practice Address - Country:US
Practice Address - Phone:708-656-9247
Practice Address - Fax:708-656-9358
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117857Medicaid
IL01638280OtherBLUE CROSS BLUE SHIELD
ILK45659Medicare PIN
IL036117857Medicaid