Provider Demographics
NPI:1023114980
Name:HABACON HILADO, EVELINA AGAWIN (MD)
Entity type:Individual
Prefix:
First Name:EVELINA
Middle Name:AGAWIN
Last Name:HABACON HILADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVELINA
Other - Middle Name:AGAWIN
Other - Last Name:HABACON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8111 W FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1536
Mailing Address - Country:US
Mailing Address - Phone:773-763-5197
Mailing Address - Fax:773-763-5197
Practice Address - Street 1:3600 W FULLERTON
Practice Address - Street 2:INFANT WELFARE SOCIETY OF CHICAGO CLINIC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2319
Practice Address - Country:US
Practice Address - Phone:773-782-2800
Practice Address - Fax:773-782-5042
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPAYEE #2Medicaid