Provider Demographics
NPI:1588896039
Name:CARRILERO, LUIS PABLO (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:PABLO
Last Name:CARRILERO
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 1:2755 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1754
Mailing Address - Country:US
Mailing Address - Phone:773-257-6665
Mailing Address - Fax:
Practice Address - Street 1:2755 W 15TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1754
Practice Address - Country:US
Practice Address - Phone:773-257-6665
Practice Address - Fax:773-257-6431
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128548207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery