Basic Information
| Provider Information | |||||||||
| NPI: | 1225279979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUEZO FUNES | ||||||||
| FirstName: | SARA | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4530 W UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | PROSPER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750789090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696077504 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4235 W NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606394852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732786868 | ||||||||
| FaxNumber: | 7732786922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2009 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.127338 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | S3911 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036.127338 | 05 | IL | MEDICAID |