Provider Demographics
NPI:1699752485
Name:MENENDEZ, CESAR E (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:E
Last Name:MENENDEZ
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 1:1137 OSTRANDER AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1349
Mailing Address - Country:US
Mailing Address - Phone:773-972-8925
Mailing Address - Fax:
Practice Address - Street 1:1137 OSTRANDER AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1349
Practice Address - Country:US
Practice Address - Phone:773-972-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064511208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL036064511Medicaid
IL036064511Medicaid
ILE 41886Medicare UPIN