Provider Demographics
NPI:1073727400
Name:HILAO, LOURDES MELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:MELLA
Last Name:HILAO
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 1:200 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-5015
Mailing Address - Country:US
Mailing Address - Phone:312-747-2823
Mailing Address - Fax:312-747-2851
Practice Address - Street 1:4243 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2049
Practice Address - Country:US
Practice Address - Phone:773-489-5110
Practice Address - Fax:773-489-5111
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366005820-60604-01Medicare ID - Type Unspecified