Provider Demographics
NPI:1245410315
Name:ANGELA INTILI MD LTD
Entity Type:Organization
Organization Name:ANGELA INTILI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:INTILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-729-2084
Mailing Address - Street 1:1415 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2873
Mailing Address - Country:US
Mailing Address - Phone:815-729-2084
Mailing Address - Fax:815-729-2304
Practice Address - Street 1:1415 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2873
Practice Address - Country:US
Practice Address - Phone:815-729-2084
Practice Address - Fax:815-729-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087434Medicaid
IL584580Medicare PIN