Healthcare Provider Details

I. General information

NPI: 1134399678
Provider Name (Legal Business Name): ALGONQUIN FAMILY HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 HUNTINGTON DR N
ALGONQUIN IL
60102-4419
US

IV. Provider business mailing address

2220 HUNTINGTON DR N
ALGONQUIN IL
60102-4419
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-0050
  • Fax:
Mailing address:
  • Phone: 847-854-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036097738
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036094916
License Number StateIL

VIII. Authorized Official

Name: ARSENIO ATADERO
Title or Position: PRESIDENT
Credential: MD
Phone: 847-854-0050