Jesus Aquino, MD
Individual provider Active NPI Anatomic Pathology & Clinical Pathology Physician · Dekalb, IL
NPI 1477635183 · NPPES record last updated Jul 30, 2010
Key facts
- NPI
- 1477635183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- 036045080 (IL)
- Practice address
- 2911 Sycamore Rd
Dekalb, IL 60115-9205 - Phone
- (815) 756-1521
- NPI assigned
- Oct 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036045080 | IL | MD | Anatomic Pathology & Clinical Pathology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 036045080 | IL | Yes |
Addresses
Primary practice location
2911 Sycamore Rd
Dekalb, IL 60115-9205
Mailing address
PO Box 2184
Indianapolis, IN 46206-2184
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00239914 | Other | RAILROAD MEDICARE | |
| 1922250 | Other | IL | BCBS IL |
| 036045080 | Medicaid | IL |
Other providers in Dekalb, IL
- Rebecca Andrews
- Anesthesia Associates LTD.
- David Robert Anthony
- Aperion Care Dekalb LLC
- Aperion Care Dekalb LLC
- Cecilia Arana
- Gregory J Arnold
- Kristinalynn Arroyo
- Abigail Ascencio
- Munjum Ashu
All providers in Dekalb, IL · Anatomic Pathology & Clinical Pathology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.