Provider Demographics
NPI:1700884194
Name:ATADERO, ARSENIO D (MD)
Entity Type:Individual
Prefix:DR
First Name:ARSENIO
Middle Name:D
Last Name:ATADERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4419
Mailing Address - Country:US
Mailing Address - Phone:847-854-0050
Mailing Address - Fax:847-854-0055
Practice Address - Street 1:2220 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4419
Practice Address - Country:US
Practice Address - Phone:847-854-0050
Practice Address - Fax:847-854-0055
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632094OtherBLUE CROSS BLUE SHIELD
IL036094916Medicaid
ILG54147Medicare UPIN
ILK05204Medicare ID - Type UnspecifiedLOCALITY 99
IL036094916Medicaid
ILK05202Medicare ID - Type UnspecifiedLOCALITY 15