Provider Demographics
NPI:1871682294
Name:AGUILAR, JEFF MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:MICHAEL
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HOUBOLT RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9063
Mailing Address - Country:US
Mailing Address - Phone:815-725-5950
Mailing Address - Fax:815-725-3666
Practice Address - Street 1:1100 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9063
Practice Address - Country:US
Practice Address - Phone:815-725-5950
Practice Address - Fax:815-725-3666
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002804363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209286Medicare PIN
IL209287Medicare PIN