Provider Demographics
NPI:1922097831
Name:OLIVERA, ARTURO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTURO
Middle Name:
Last Name:OLIVERA
Suffix:JR
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 1:3004 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3012
Mailing Address - Country:US
Mailing Address - Phone:773-871-4600
Mailing Address - Fax:773-871-2900
Practice Address - Street 1:3004 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3012
Practice Address - Country:US
Practice Address - Phone:773-871-4600
Practice Address - Fax:773-871-2900
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073024207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073024Medicaid
IL036073024OtherSTATE OF ILLINOIS LICENSE
IL0001628796OtherILLINOIS BCBS
L03460Medicare ID - Type Unspecified
IL036073024Medicaid
IL208769Medicare PIN
E18382Medicare UPIN