Provider Demographics
NPI:1790753341
Name:MIGONE, ANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:
Last Name:MIGONE
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:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:2601 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1031
Practice Address - Country:US
Practice Address - Phone:618-549-5361
Practice Address - Fax:618-351-4878
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083484Medicaid
IL3932056OtherBCBS OF IL
IL142064OtherGHP INSURANCE PROVIDER #
IL80037470OtherRR MEDICARE
IL176923OtherHEALTHLINK INSURANCE #
IL324145OtherGHP PROVIDER NUMBER
IL7210895OtherAETNA
IL027532OtherHAMP INSURANCE #
IL214881Medicare PIN
IL176923OtherHEALTHLINK INSURANCE #
IL324145OtherGHP PROVIDER NUMBER
IL142064OtherGHP INSURANCE PROVIDER #
ILF39944Medicare UPIN
IL143821Medicare Oscar/Certification