NPI 1144588039

Luis Victor Fernandez

Practitioner Independent Duty Corpsman Great Lakes, IL

Practice location

Address: 2410 Sampson St, Great Lakes, IL 60088-2942
Phone: (847) 688-2469
Mailing address: 2410 Sampson St. Bldg 237, Great Lakes, IL 60088

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1144588039
Entity type: Individual
Sex (as registered): Male
NPI issued: 27 Apr 2012
Record last updated: 27 Apr 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.