Provider Demographics
NPI:1821035395
Name:FIUMARA, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:FIUMARA
Suffix:
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 1:900 JORIE BLVD
Mailing Address - Street 2:SUITE 186
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2213
Mailing Address - Country:US
Mailing Address - Phone:630-954-6700
Mailing Address - Fax:630-954-1555
Practice Address - Street 1:900 JORIE BLVD
Practice Address - Street 2:SUITE 186
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2213
Practice Address - Country:US
Practice Address - Phone:630-954-6700
Practice Address - Fax:630-954-1555
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360869992080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086999Medicaid
ILL76270OtherMEDICARE PIN - 645650
ILH11716Medicare UPIN
ILL76269Medicare PIN