Provider Demographics
NPI:1417964206
Name:TAGES, JOSEPH M (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:TAGES
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 1:330 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4767
Mailing Address - Country:US
Mailing Address - Phone:630-801-0031
Mailing Address - Fax:630-801-0199
Practice Address - Street 1:330 WESTON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4767
Practice Address - Country:US
Practice Address - Phone:630-801-0031
Practice Address - Fax:630-801-0199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071393Medicaid
IL036071393Medicaid
L55268Medicare PIN