Provider Demographics
NPI:1700888609
Name:FLICKINGER, MARIA RIZALIN GALIT (MD)
Entity Type:Individual
Prefix:
First Name:MARIA RIZALIN
Middle Name:GALIT
Last Name:FLICKINGER
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 1:23 EASTMORELAND LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3828
Mailing Address - Country:US
Mailing Address - Phone:217-454-2758
Mailing Address - Fax:
Practice Address - Street 1:1900 E LAKE SHORE DR
Practice Address - Street 2:STE 350
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3824
Practice Address - Country:US
Practice Address - Phone:217-423-2800
Practice Address - Fax:217-423-0850
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7624523OtherAETNA
263250OtherHEALTHLINK
042367OtherHEALTH ALLIANCE
5822752OtherBC/BS OF IL
5822752OtherBC/BS OF IL
520310Medicare ID - Type Unspecified