Provider Demographics
NPI:1972525269
Name:ORTEGA, CARLOS DAVID (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:DAVID
Last Name:ORTEGA
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 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 780
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-235-8887
Mailing Address - Fax:773-235-8882
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-235-8887
Practice Address - Fax:773-235-8882
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361000422086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1629966OtherBCBSIL NIESS
ILK26864OtherINDIVIDUAL MEDICARE ID
IL1630046OtherBSBSIL BSG
IL036-100042Medicaid
ILH62949Medicare UPIN
IL686000Medicare PIN
ILK26864OtherINDIVIDUAL MEDICARE ID