Provider Demographics
NPI:1578507562
Name:AURIEMMA, ANTHONY M (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:AURIEMMA
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6145
Mailing Address - Country:US
Mailing Address - Phone:630-887-2900
Mailing Address - Fax:
Practice Address - Street 1:460 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6145
Practice Address - Country:US
Practice Address - Phone:630-887-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36113958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00745243OtherRR MEDICARE PTAN
IL1617057OtherBLUE CROSS BLUE SHIELD
IL036113958-1Medicaid
ILP00432736OtherMEDICARE RAILROAD
ILIL1854001Medicare PIN
ILP00745243OtherRR MEDICARE PTAN
IL036113958-1Medicaid
ILIL2120001Medicare PIN