Provider Demographics
NPI:1821374570
Name:ARTHUR I DAVIDA MD PC
Entity Type:Organization
Organization Name:ARTHUR I DAVIDA MD PC
Other - Org Name:DOC'S SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:I
Authorized Official - Last Name:DAVIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-893-8050
Mailing Address - Street 1:105 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1212
Mailing Address - Country:US
Mailing Address - Phone:630-893-8050
Mailing Address - Fax:630-893-8154
Practice Address - Street 1:105 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1212
Practice Address - Country:US
Practice Address - Phone:630-893-8050
Practice Address - Fax:630-893-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070839261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070839Medicaid
IL774930Medicare PIN
IL036070839Medicaid