Provider Demographics
NPI:1417944653
Name:AQUINO, LOUIS (DPM)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:AQUINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-0340
Mailing Address - Country:US
Mailing Address - Phone:618-344-4449
Mailing Address - Fax:
Practice Address - Street 1:122 E ZUPAN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-2010
Practice Address - Country:US
Practice Address - Phone:618-344-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO117421OtherHEALTHLINK
MO24827OtherBC/BS OF MISSOURI
IL2750074OtherUHC MIDWEST
MO117421OtherHEALTHLINK
ILP16113Medicare PIN
MO24827OtherBC/BS OF MISSOURI