1093004079 NPI number — ANGELA AMELIA GANAN POPA MD

Table of content: ANGELA AMELIA GANAN POPA MD (NPI 1093004079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093004079 NPI number — ANGELA AMELIA GANAN POPA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANAN POPA
Provider First Name:
ANGELA
Provider Middle Name:
AMELIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GANAN SOTO
Provider Other First Name:
ANGELA
Provider Other Middle Name:
AMELIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093004079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 BARRINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-437-5500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 BIESTERFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE VILLAGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60007-3397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-437-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  TRN 12296 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD13547 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0205X , with the licence number: 036135985 , 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)