Provider Demographics
NPI:1225450497
Name:ENIO A RIGOLIN MD SC
Entity Type:Organization
Organization Name:ENIO A RIGOLIN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIGOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-241-1495
Mailing Address - Street 1:343 PARK PL
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1269
Mailing Address - Country:US
Mailing Address - Phone:630-241-1495
Mailing Address - Fax:630-241-1543
Practice Address - Street 1:600 N MCCLURG CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3044
Practice Address - Country:US
Practice Address - Phone:630-241-1495
Practice Address - Fax:630-241-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360431552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043155Medicaid