Active NPI
Mark Anthony Real Hidalgo, PT
- Physical Therapist
- Morton Grove, IL
National Provider Identifier
1992391353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 70020653
- Practice address
- 7436 Foster St
Morton Grove, IL 60053-1151 - Phone
- (312) 330-0183
- NPI assigned
- Dec 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 70020653 | IL | Primary |
Addresses
Primary practice location
7436 Foster St
Morton Grove, IL 60053-1151
Mailing address
7436 Foster St
Morton Grove, IL 60053-1151
Phone (312) 330-0183
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 |
|---|---|---|---|
| 70020653 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608249600000",
"number": "1992391353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7436 FOSTER ST",
"city": "MORTON GROVE",
"state": "IL",
"postal_code": "600531151",
"telephone_number": "312-330-0183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7436 FOSTER ST",
"city": "MORTON GROVE",
"state": "IL",
"postal_code": "600531151",
"telephone_number": "312-330-0183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HIDALGO",
"first_name": "MARK ANTHONY",
"middle_name": "REAL",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-18",
"last_updated": "2020-12-18",
"certification_date": "2020-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "70020653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morton Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.