Fernandez, Dolores R.

Fernandez, Dolores R. is an individual health care provider with primary practice located at 101 W University Ave , Champaign IL 61820-3981. She recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as her primary health care specialty. Fernandez, Dolores R. can be contacted via phone (217) 366-1285.

Contact Information

Primary practice address
101 W University Ave Champaign IL 61820-3981
Phone: (217) 366-1285
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 036-064412 Illinois

Profile Details

NPI number 1578570842
LBN Legal business name Fernandez, Dolores R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2006
Last updated Jan 5th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578570842 NPPES
Illinois MEDICAID 036064412 2
Illinois Other 300024387
Illinois Other 279500

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