1588789309 NPI number — MRS. SELENA KAY TADO LPT

Table of content: MRS. SELENA KAY TADO LPT (NPI 1588789309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588789309 NPI number — MRS. SELENA KAY TADO LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TADO
Provider First Name:
SELENA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPT
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:
1588789309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 QUEENSBURY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALGONQUIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60102-6512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-333-0384
Provider Business Mailing Address Fax Number:
847-669-6190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10436 ROUTE 47
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
HUNTLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-515-3366
Provider Business Practice Location Address Fax Number:
847-515-3356
Provider Enumeration Date:
03/20/2007

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: 174400000X , 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)





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