=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912173675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARTURO OLIVERA JR.,M.D. LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2008
-----------------------------------------------------
Last Update Date | 06/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 E NORTHWEST HWY
-----------------------------------------------------
City | MOUNT PROSPECT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60056-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-651-2304
-----------------------------------------------------
Fax | 847-724-0675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 E NORTHWEST HWY
-----------------------------------------------------
City | MOUNT PROSPECT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60056-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-651-2304
-----------------------------------------------------
Fax | 847-724-0675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ARTURO OLIVERA JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 847-651-2304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 036073024
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------