Healthcare Provider Details

I. General information

NPI: 1992988356
Provider Name (Legal Business Name): ARIS JOHN B ARENAS RSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 IONE LN
AURORA IL
60503-7826
US

IV. Provider business mailing address

1999 IONE LN
AURORA IL
60503-7826
US

V. Phone/Fax

Practice location:
  • Phone: 847-208-6982
  • Fax:
Mailing address:
  • Phone: 847-208-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238.000181
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number238.000181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: