Provider Demographics
NPI:1528387099
Name:MARIA NIDA V. BARINO MD LTD
Entity Type:Organization
Organization Name:MARIA NIDA V. BARINO MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA NIDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-914-7720
Mailing Address - Street 1:685 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1752
Mailing Address - Country:US
Mailing Address - Phone:630-759-1052
Mailing Address - Fax:630-759-1233
Practice Address - Street 1:685 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1752
Practice Address - Country:US
Practice Address - Phone:630-759-1052
Practice Address - Fax:630-759-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336051420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089667Medicaid