Provider Demographics
NPI:1932112414
Name:UBAIDUR PAPA
Entity Type:Organization
Organization Name:UBAIDUR PAPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:UBAIDUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-455-1266
Mailing Address - Street 1:460 COVENTRY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7561
Mailing Address - Country:US
Mailing Address - Phone:815-455-1266
Mailing Address - Fax:815-455-0789
Practice Address - Street 1:460 COVENTRY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7561
Practice Address - Country:US
Practice Address - Phone:815-455-1266
Practice Address - Fax:815-455-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36044800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37260 ILMedicare UPIN