Provider Demographics
NPI:1427512847
Name:HERMIDA DE VIVEIROS, PEDRO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANTONIO
Last Name:HERMIDA DE VIVEIROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:233 E SUPERIOR ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2913
Mailing Address - Country:US
Mailing Address - Phone:312-926-9636
Mailing Address - Fax:312-695-1106
Practice Address - Street 1:233 E SUPERIOR ST FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2913
Practice Address - Country:US
Practice Address - Phone:312-926-9636
Practice Address - Fax:312-695-1106
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036157214207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology