Provider Demographics
NPI:1093876534
Name:PADEN, ARLENE ANGELA (MD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:ANGELA
Last Name:PADEN
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:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-0441
Mailing Address - Country:US
Mailing Address - Phone:240-346-3439
Mailing Address - Fax:
Practice Address - Street 1:2081 CALISTOGA DR
Practice Address - Street 2:SUITE 2S
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4831
Practice Address - Country:US
Practice Address - Phone:815-418-6070
Practice Address - Fax:779-803-3119
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1395642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD546921000Medicaid
MDKK34HG05Medicare ID - Type Unspecified
MD546921000Medicaid