Healthcare Provider Details

I. General information

NPI: 1316988231
Provider Name (Legal Business Name): ENRIQUE A ARANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 N SHERIDAN RD 18A
CHICAGO IL
60660-3870
US

IV. Provider business mailing address

5801 N SHERIDAN RD 18A
CHICAGO IL
60660-3870
US

V. Phone/Fax

Practice location:
  • Phone: 773-816-2007
  • Fax: 773-334-4931
Mailing address:
  • Phone: 773-816-2007
  • Fax: 773-334-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-065896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: