Healthcare Provider Details

I. General information

NPI: 1023114980
Provider Name (Legal Business Name): EVELINA AGAWIN HABACON HILADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELINA AGAWIN HABACON MD

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W FULLERTON INFANT WELFARE SOCIETY OF CHICAGO CLINIC
CHICAGO IL
60647-2319
US

IV. Provider business mailing address

8111 W FARRAGUT AVE
CHICAGO IL
60656-1536
US

V. Phone/Fax

Practice location:
  • Phone: 773-782-2800
  • Fax: 773-782-5042
Mailing address:
  • Phone: 773-763-5197
  • Fax: 773-763-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-050690
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: