1659555688 NPI number — GINA MARIE BAKIARES DPM, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659555688 NPI number — GINA MARIE BAKIARES DPM, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GINA MARIE BAKIARES DPM, P.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:
6
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:
1659555688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4236 WHITE BIRCH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-1251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-852-0888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 OGDEN AVE.
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504-6065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-851-1329
Provider Business Practice Location Address Fax Number:
630-851-8837
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKIARES
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
630-852-0888

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  016003316 , 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: 016003316 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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