1063512986 NPI number — DR. ARACELI ILAGAN FERIA M.D.

Table of content: DR. ARACELI ILAGAN FERIA M.D. (NPI 1063512986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063512986 NPI number — DR. ARACELI ILAGAN FERIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERIA
Provider First Name:
ARACELI
Provider Middle Name:
ILAGAN
Provider Name Prefix Text:
DR.
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:
1063512986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2009
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:
09/22/2006

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: 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: 133901001 . This is a "TRAVELERS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 080084981 . This is a "PALMETTO, GBA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: C07F03 . This is a "AETNA HEALTH PLANS" 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 CHOICE" 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: 791082109 . This is a "MEDICARE PALMETTO GBA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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