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General NPI Number Information
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NPI Number | 1366616864
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Entity Type | Individual
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Provider Name | MIGUEL A AGUILERA MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 400 N PLEASANT AVE
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City | CENTRALIA
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State | IL
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Zip | 62801-3098
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Country | US
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Telephone | 618-436-6318
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Fax | 618-436-6386
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Provider Business Mailing Address
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Address Line | 400 N PLEASANT AVE
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City | CENTRALIA
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State | IL
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Zip | 62801-3098
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Country | US
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Telephone | 618-436-6318
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Fax | 618-436-6386
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 67178
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | 67178
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 036072026
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License Number State | IL
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