1093876534 NPI number — ARLENE ANGELA PADEN M.D.

Table of content: ARLENE ANGELA PADEN M.D. (NPI 1093876534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093876534 NPI number — ARLENE ANGELA PADEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADEN
Provider First Name:
ARLENE
Provider Middle Name:
ANGELA
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:
1093876534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 441
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOSSMOOR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60422-0441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-346-3439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2081 CALISTOGA DR
Provider Second Line Business Practice Location Address:
SUITE 2S
Provider Business Practice Location Address City Name:
NEW LENOX
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60451-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-418-6070
Provider Business Practice Location Address Fax Number:
779-803-3119
Provider Enumeration Date:
12/12/2006

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: 2084P0800X , with the licence number:  036.139564 , 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: 546921000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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