Provider Demographics
NPI:1093276016
Name:AREBANMHEN, IDIA (MD)
Entity Type:Individual
Prefix:
First Name:IDIA
Middle Name:
Last Name:AREBANMHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IDIA
Other - Middle Name:
Other - Last Name:IFIANAYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:319 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1133
Mailing Address - Country:US
Mailing Address - Phone:224-735-0611
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036162337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics