Provider Demographics
NPI:1073746871
Name:ARIZA ALTAHONA, MARIA D (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:ARIZA ALTAHONA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4201 WINFIELD RD
Mailing Address - Street 2:CENTRALIZED SERVICES 4TH FL
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:331-221-2357
Practice Address - Street 1:130 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-3957
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2021-04-09
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Provider Licenses
StateLicense IDTaxonomies
IL036128885207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128885Medicaid
IL324020018Medicare Oscar/Certification