Provider Demographics
NPI:1952492829
Name:BADILLO, ISABELLE KRISTEN (PA)
Entity Type:Individual
Prefix:MS
First Name:ISABELLE
Middle Name:KRISTEN
Last Name:BADILLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 BARRINGTON RD
Mailing Address - Street 2:605
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1090
Mailing Address - Country:US
Mailing Address - Phone:847-755-1111
Mailing Address - Fax:847-755-1166
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:605
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1090
Practice Address - Country:US
Practice Address - Phone:847-755-1111
Practice Address - Fax:847-755-1166
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010044363A00000X
IL085002906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid
NY00330128Medicare ID - Type Unspecified