Provider Demographics
NPI:1366490658
Name:ALENGHAT, JOSEPH PORINCHU (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PORINCHU
Last Name:ALENGHAT
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 1:1709 JUMER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-0914
Mailing Address - Country:US
Mailing Address - Phone:309-665-0640
Mailing Address - Fax:309-664-6809
Practice Address - Street 1:1709 JUMER DR
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-0914
Practice Address - Country:US
Practice Address - Phone:309-665-0640
Practice Address - Fax:309-664-6809
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1334362085R0202X
VA1012422822085R0202X
IL036-0614932085R0202X
DC73542085R0202X
CT177572085R0202X
MA433622085R0202X
OH35.0910852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212545OtherGROUP PTAN
IL036061493Medicaid
IL202926OtherGROUP PTAN
IL300132246Medicare PIN
IL300122655Medicare PIN
IL212545OtherGROUP PTAN
ILL82801Medicare PIN
ILL61340Medicare PIN
ILCH0689Medicare PIN
ILL91350Medicare PIN
ILP00315762Medicare PIN
IL202926OtherGROUP PTAN
ILK22472Medicare PIN