1801849161 NPI number — LISA C PELLEGRINI M.D.

Table of content: LISA C PELLEGRINI M.D. (NPI 1801849161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801849161 NPI number — LISA C PELLEGRINI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELLEGRINI
Provider First Name:
LISA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1801849161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 N MILL ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-6304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-646-8000
Provider Business Mailing Address Fax Number:
630-646-8007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 N MILL ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-6304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-646-8000
Provider Business Practice Location Address Fax Number:
630-646-8007
Provider Enumeration Date:
05/18/2006

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: 2084N0400X , with the licence number:  036099958 , 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: 036099958 2 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2220936 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".