Provider Demographics
NPI:1619453412
Name:DE LA CRUZ TEJADA, ANGEL CRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:CRISTIAN
Last Name:DE LA CRUZ TEJADA
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 1:180 HARVESTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6686
Mailing Address - Country:US
Mailing Address - Phone:773-702-1150
Mailing Address - Fax:
Practice Address - Street 1:5841 S. MARYLAND AVENUE MC 1052
Practice Address - Street 2:DPT. OF GME ROOM J-141
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1470
Practice Address - Country:US
Practice Address - Phone:773-702-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.168196207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease