Provider Demographics
NPI:1740267756
Name:MEDINA, HELIODORO (MD)
Entity type:Individual
Prefix:
First Name:HELIODORO
Middle Name:
Last Name:MEDINA
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 1:302 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4220
Mailing Address - Country:US
Mailing Address - Phone:630-262-7400
Mailing Address - Fax:630-262-3760
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4220
Practice Address - Country:US
Practice Address - Phone:630-262-7400
Practice Address - Fax:630-262-3760
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104186207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400100146OtherMEDICARE PTAN (INDIVIDUAL)
IL036100061Medicaid
ILCA4748OtherRAILROAD MEDICARE (GROUP PTAN)
ILP01248201OtherRAILROAD MEDICARE (PROVIDER PTAN)
IL206147OtherMEDICARE PTAN (GROUP)
IL206147OtherMEDICARE PTAN (GROUP)
ILCA4748OtherRAILROAD MEDICARE (GROUP PTAN)