Provider Demographics
NPI:1164686218
Name:ROMERO UBILLUS, WILFREDO JOSE (MD)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:JOSE
Last Name:ROMERO UBILLUS
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 1:365 N HALSTED ST APT 2202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1377
Mailing Address - Country:US
Mailing Address - Phone:313-354-5715
Mailing Address - Fax:
Practice Address - Street 1:101 MADISON ST STE 3
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:707-486-2700
Practice Address - Fax:708-486-2702
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130680207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine