Provider Demographics
NPI:1013968239
Name:SIA, IMELDA ANDAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:ANDAYA
Last Name:SIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 N DOWAGIAC AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3021
Mailing Address - Country:US
Mailing Address - Phone:847-208-7994
Mailing Address - Fax:
Practice Address - Street 1:113 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1006
Practice Address - Country:US
Practice Address - Phone:630-894-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1740404680OtherMEDICARE GROUP NPI
IL036087532Medicaid
IL1740404680OtherMEDICARE GROUP NPI