Provider Demographics
NPI:1457359739
Name:DEMARCO-PAITL, LAURA (DO)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:DEMARCO-PAITL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DEMARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4717
Mailing Address - Country:US
Mailing Address - Phone:847-214-5764
Mailing Address - Fax:847-214-5777
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4717
Practice Address - Country:US
Practice Address - Phone:847-214-5764
Practice Address - Fax:847-214-5777
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL610033301OtherDOL WORKCOMP
IL04532170OtherBLUE CROSS BLUE SHIELD
IL036085218Medicaid
ILDB0387OtherRAILROAD MEDICARE GROUP
ILE49120Medicare UPIN
IL04532170OtherBLUE CROSS BLUE SHIELD
IL036085218Medicaid