Provider Demographics
NPI:1629018890
Name:PORADA, JOSEPH JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:PORADA
Suffix:JR
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 1:1200 HARGER RD STE 408
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1818
Mailing Address - Country:US
Mailing Address - Phone:630-581-6538
Mailing Address - Fax:630-645-6446
Practice Address - Street 1:1200 HARGER RD STE 408
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1818
Practice Address - Country:US
Practice Address - Phone:630-581-6538
Practice Address - Fax:630-645-6446
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360557602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055760Medicaid
IL300025952Medicare PIN
IL207007Medicare PIN
ILC51338Medicare UPIN
ILIL7584032Medicare PIN
ILIL7522037Medicare PIN
IL300136834Medicare PIN