Provider Demographics
NPI:1457499865
Name:ALIAGA, FEDERICO J (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:J
Last Name:ALIAGA
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 1:2859 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4456
Mailing Address - Country:US
Mailing Address - Phone:773-762-3333
Mailing Address - Fax:
Practice Address - Street 1:2859 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4456
Practice Address - Country:US
Practice Address - Phone:773-762-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623061OtherBLUE CROSS &BLUE SHIELD
IL521830Medicare ID - Type Unspecified
IL01623061OtherBLUE CROSS &BLUE SHIELD