Provider Demographics
NPI:1679626717
Name:MORARIU, ISTINA (MD)
Entity Type:Individual
Prefix:
First Name:ISTINA
Middle Name:
Last Name:MORARIU
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 1:5330 W DEVON AVE
Mailing Address - Street 2:STE. #14
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4108
Mailing Address - Country:US
Mailing Address - Phone:312-505-0938
Mailing Address - Fax:
Practice Address - Street 1:100 N RIVER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1209
Practice Address - Country:US
Practice Address - Phone:847-297-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097205282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635967OtherBLUE CROSS BLUE SHIELD
IL036097205Medicaid