Provider Demographics
NPI:1750405221
Name:YUNEZ, SALVADOR ROQUE (MD)
Entity type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:ROQUE
Last Name:YUNEZ
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 1:6745 N CLARK ST
Mailing Address - Street 2:1 N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3220
Mailing Address - Country:US
Mailing Address - Phone:773-743-4958
Mailing Address - Fax:773-743-0150
Practice Address - Street 1:6745 N CLARK ST
Practice Address - Street 2:1 N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3220
Practice Address - Country:US
Practice Address - Phone:773-743-4958
Practice Address - Fax:773-743-0150
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist