Active NPI
Enrique V Herrera Estrada, SURGICAL ASSISTANT
- Surgical Assistant
- Oak Lawn, IL
National Provider Identifier
1639948672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 23-766
- Practice address
- 6201 W 95TH St
Oak Lawn, IL 60453-3888 - Phone
- (708) 636-9393
- NPI assigned
- Jan 1, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 23-766 | WI | Primary |
Addresses
Primary practice location
6201 W 95TH St
Oak Lawn, IL 60453-3888
Mailing address
2211 S Highland Ave Apt 4C
Lombard, IL 60148-5349
Phone (708) 513-1584
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-766 | WI | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704067200000",
"number": "1639948672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2211 S HIGHLAND AVE APT 4C",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601485349",
"telephone_number": "708-513-1584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6201 W 95TH ST",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604533888",
"telephone_number": "708-636-9393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRERA ESTRADA",
"first_name": "ENRIQUE",
"middle_name": "V",
"credential": "SURGICAL ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-01",
"last_updated": "2024-01-01",
"certification_date": "2023-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "WI",
"license": "23-766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Lawn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.