1629213269 NPI number — VIPAL K ARORA MD SC

Table of content: (NPI 1629213269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629213269 NPI number — VIPAL K ARORA MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIPAL K ARORA MD SC
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:
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:
1629213269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3825 S. HIGHLAND AVE
Provider Second Line Business Mailing Address:
STE 5J
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-968-1100
Provider Business Mailing Address Fax Number:
630-968-8178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3825 S. HIGHLAND AVE
Provider Second Line Business Practice Location Address:
STE 5J
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-968-1100
Provider Business Practice Location Address Fax Number:
630-968-8178
Provider Enumeration Date:
12/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARORA
Authorized Official First Name:
VIPAL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
630-968-1100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  03605105 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 036051015 , 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: 03605015 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".