1871773424 NPI number — ARACELI I. FERIA, M.D.S.C.

Table of content: (NPI 1871773424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871773424 NPI number — ARACELI I. FERIA, M.D.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARACELI I. FERIA, M.D.S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871773424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10448 S PULASKI RD
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453-4895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-636-6531
Provider Business Mailing Address Fax Number:
708-636-6549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10448 S PULASKI RD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-4895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-636-6531
Provider Business Practice Location Address Fax Number:
708-636-6549
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERIA
Authorized Official First Name:
ARACELI
Authorized Official Middle Name:
ILAGAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-636-6531

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036054271 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063512986 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: C07F03 . This is a "AETNA HEALTH PLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036054271 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080084981 . This is a "PALMETTO, GBA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 21606679 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4064717 . This is a "AETNA MANAGED CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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