Provider Demographics
NPI:1528477312
Name:ITURBIDE SILES, PEDRO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANTONIO
Last Name:ITURBIDE SILES
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 1:830 W DIVERSEY PKWY
Mailing Address - Street 2:SUIT 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1454
Mailing Address - Country:US
Mailing Address - Phone:312-952-5876
Mailing Address - Fax:
Practice Address - Street 1:830 W DIVERSEY PKWY
Practice Address - Street 2:SUIT 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1454
Practice Address - Country:US
Practice Address - Phone:312-952-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.065899207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine