Provider Demographics
NPI:1306831300
Name:DAVIDA, ARTHUR I (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:I
Last Name:DAVIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1212
Mailing Address - Country:US
Mailing Address - Phone:630-893-8050
Mailing Address - Fax:630-893-8154
Practice Address - Street 1:105 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1212
Practice Address - Country:US
Practice Address - Phone:630-893-8050
Practice Address - Fax:630-893-8154
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-03-26
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IL036070839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31602572OtherIL BLUESHIELD ID
IL0585994OtherAETNA HMO
IL080097634OtherRAILROAD MEDICARE
IL775782OtherUNITEDHEALTHCARE
IL40642891OtherAETNA NON HMO
IL14D0415194OtherCLIA
IL036070839Medicaid
IL1821374570OtherGROUP NPI
IL278579100OtherUS DEPT OF LABOR
ILD16507Medicare UPIN
IL774930Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID