Provider Demographics
NPI:1740404680
Name:IMELDA A. SIA, M.D., S.C.
Entity Type:Organization
Organization Name:IMELDA A. SIA, M.D., S.C.
Other - Org Name:GLENDALE HEIGHTS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-894-8600
Mailing Address - Street 1:113 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1006
Mailing Address - Country:US
Mailing Address - Phone:630-894-8600
Mailing Address - Fax:630-894-8632
Practice Address - Street 1:113 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1006
Practice Address - Country:US
Practice Address - Phone:630-894-8600
Practice Address - Fax:630-894-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087532Medicaid
IL971670OtherMEDICARE PTAN
IL2230310OtherBLUE CROSS BLUE SHIELD
IL971670OtherMEDICARE PTAN