Provider Demographics
NPI:1528222353
Name:TAPIA MEDICAL GROUP, LTD
Entity Type:Organization
Organization Name:TAPIA MEDICAL GROUP, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-771-5490
Mailing Address - Street 1:7318 MADISON ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-3100
Mailing Address - Country:US
Mailing Address - Phone:708-771-5490
Mailing Address - Fax:708-771-5491
Practice Address - Street 1:7318 MADISON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-3100
Practice Address - Country:US
Practice Address - Phone:708-771-5490
Practice Address - Fax:708-771-5491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094129261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094129Medicaid