Provider Demographics
NPI:1073602660
Name:AQUINO, LINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:L
Last Name:AQUINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 W HOLLYWOOD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-284-4579
Mailing Address - Fax:773-284-4579
Practice Address - Street 1:2222 W DIVISION
Practice Address - Street 2:RM 350
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-772-2750
Practice Address - Fax:773-772-2750
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609678OtherBLUE SHIELD
C45553Medicare UPIN
IL21609678OtherBLUE SHIELD