Provider Demographics
NPI:1356358873
Name:ESTRADA, JANUARIO PURISIMA III (MD)
Entity type:Individual
Prefix:
First Name:JANUARIO
Middle Name:PURISIMA
Last Name:ESTRADA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64568
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-4568
Mailing Address - Country:US
Mailing Address - Phone:630-288-6200
Mailing Address - Fax:855-781-4084
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:#306
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1090
Practice Address - Country:US
Practice Address - Phone:847-844-3199
Practice Address - Fax:847-844-1536
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074492Medicaid
IL110196734OtherRAILROAD MEDICARE
IL0021623344OtherBCBS PROVIDER ID
ILD89968Medicare UPIN