Provider Demographics
NPI:1033131974
Name:PRISCO I. OLAYA JR. M.D. S.C.
Entity Type:Organization
Organization Name:PRISCO I. OLAYA JR. M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCO
Authorized Official - Middle Name:I
Authorized Official - Last Name:OLAYA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:773-581-8080
Mailing Address - Street 1:6222 S PULASKI RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4610
Mailing Address - Country:US
Mailing Address - Phone:773-581-8080
Mailing Address - Fax:
Practice Address - Street 1:6222 S PULASKI RD
Practice Address - Street 2:STE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4610
Practice Address - Country:US
Practice Address - Phone:773-581-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL021607326OtherBLUE CROSS/BLUE SHIELD
IL036048022Medicaid
IL036048022Medicaid
IL036048022Medicaid
IL211600Medicare PIN