Provider Demographics
NPI: | 1841237401 |
---|---|
Name: | ARNECILLA, PABLO (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | PABLO |
Middle Name: | |
Last Name: | ARNECILLA |
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
State | License ID | Taxonomies |
---|---|---|
IL | 036051583 | 208000000X |
IL | 036-051583 | 2080N0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 036051583 | Medicaid | |
IL | L39615 | Medicare PIN | |
IL | 036051583 | Medicaid |