Antonio B. Cruz M.D.S.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

3640977 Issued in IL

Legal business name

ANTONIO B. CRUZ M.D.S.C.

Practice address

1601 Tanglewood Ave Ste 106
Hanover Park, IL 60133-3381

Phone

(630) 289-7800

Fax

(630) 289-9187

NPI assigned

Jul 18, 2008

Last updated

Oct 17, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Antonio B. Cruz, M.D.NPI 1013013374

Title

President

Phone

(630) 289-7800

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Antonio B Cruz, MD

  • General Practice Physician
  • Hanover Park, IL
  • NPI 1013013374
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224201600000",
    "number": "1356506307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 TANGLEWOOD AVE STE 106",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601333381",
            "telephone_number": "630-289-7800",
            "fax_number": "630-289-9187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 TANGLEWOOD AVE STE 106",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601333381",
            "telephone_number": "630-289-7800",
            "fax_number": "630-289-9187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTONIO B. CRUZ M.D.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2008-10-17",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-289-7800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "3640977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036040977",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "362175536",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Hanover Park, IL
• Providers in Hanover Park, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.