Provider Demographics
NPI:1114367505
Name:ANGEL MARIA MEDICAL INC.
Entity Type:Organization
Organization Name:ANGEL MARIA MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA NIDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-207-3962
Mailing Address - Street 1:1824 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-3842
Mailing Address - Country:US
Mailing Address - Phone:773-376-4040
Mailing Address - Fax:773-890-1203
Practice Address - Street 1:1824 W 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3842
Practice Address - Country:US
Practice Address - Phone:773-376-4040
Practice Address - Fax:773-890-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty