Provider Demographics
NPI:1982625034
Name:FERNANDO HERNANDEZ MD SC
Entity type:Organization
Organization Name:FERNANDO HERNANDEZ MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-2356
Mailing Address - Street 1:1725 W HARRISON ST STE 843
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3866
Mailing Address - Country:US
Mailing Address - Phone:312-942-2356
Mailing Address - Fax:312-942-5313
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 843
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-2356
Practice Address - Fax:312-942-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601998OtherBLUE CROSS / BLUE SHIELD
IL31601998OtherBLUE CROSS / BLUE SHIELD
216858Medicare ID - Type Unspecified