Provider Demographics
NPI:1063509172
Name:D'AQUILA, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:D'AQUILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E. SUPERIOR ST,
Mailing Address - Street 2:LURIE 9-159
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3015
Mailing Address - Country:US
Mailing Address - Phone:312-503-4876
Mailing Address - Fax:312-908-2528
Practice Address - Street 1:676 N. ST. CLAIR
Practice Address - Street 2:ARKES 940
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3015
Practice Address - Country:US
Practice Address - Phone:312-503-4876
Practice Address - Fax:312-908-2528
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131161207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D88757Medicare UPIN