Provider Demographics
NPI:1447353230
Name:FIGUEREDO, JORGE VALENTIN (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:VALENTIN
Last Name:FIGUEREDO
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 1:1634 W WARREN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3224
Mailing Address - Country:US
Mailing Address - Phone:708-269-8162
Mailing Address - Fax:
Practice Address - Street 1:1634 W WARREN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3224
Practice Address - Country:US
Practice Address - Phone:708-269-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067070A207Q00000X
IL036058621208600000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058621Medicaid
P00115376OtherR/R MEDICARE
IL036058621Medicaid
P00115376OtherR/R MEDICARE
ILK04395Medicare ID - Type Unspecified
ILD29465Medicare UPIN