Provider Demographics
NPI:1659358703
Name:SY, ESTHER ALIMBOYAO (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:ALIMBOYAO
Last Name:SY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N ROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3619
Mailing Address - Country:US
Mailing Address - Phone:815-971-2000
Mailing Address - Fax:815-968-9340
Practice Address - Street 1:2300 N ROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3619
Practice Address - Country:US
Practice Address - Phone:815-971-2000
Practice Address - Fax:815-968-9340
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36097622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL553180OtherMEDICARE GROUP #
IL036097622Medicaid
ILCC5050Medicare ID - Type UnspecifiedRR MEDICARE GROUP #
G84896Medicare UPIN
IL036097622Medicaid
ILL94074Medicare ID - Type Unspecified
ILK13735Medicare PIN
IL769380 - L81619Medicare PIN
IL553180OtherMEDICARE GROUP #
IL080133742Medicare ID - Type UnspecifiedRR INDIVIDUAL #