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General NPI Number Information
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NPI Number | 1114367505
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Entity Type | Organization
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Legal Business Name | ANGEL MARIA MEDICAL INC.
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 1824 W 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-3842
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Country | US
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Telephone | 773-376-4040
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Fax | 773-890-1203
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Provider Business Mailing Address
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Address Line | 1824 W 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-3842
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Country | US
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Telephone | 773-376-4040
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Fax | 773-890-1203
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Authorized Official
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Title or Position | OWNER
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Name | MISS MARIA NIDA V BARINO
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Credential | MD
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Telephone | 630-207-3962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036089667
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License Number State | IL
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