Provider Demographics
NPI:1376527739
Name:AKLILU, MEBEA (MD)
Entity Type:Individual
Prefix:
First Name:MEBEA
Middle Name:
Last Name:AKLILU
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 1:701 LEE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4539
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:901 W WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6708
Practice Address - Country:US
Practice Address - Phone:773-296-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00793207RH0003X, 207RX0202X
IL036-110116207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D6160OtherMEDCOST
SCQ0079FMedicaid
VA10098114Medicaid
7884652OtherAETNA
NC89137G7Medicaid
137G7OtherBCBS
804595OtherPARTNERS
WV3810000695Medicaid
137G7OtherBCBS
804595OtherPARTNERS
P00117265Medicare PIN