1184615387 NPI number — EUGENE MANDREA, M.D., S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184615387 NPI number — EUGENE MANDREA, M.D., S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUGENE MANDREA, M.D., S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184615387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1730 PARK ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-2688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-718-0200
Provider Business Mailing Address Fax Number:
630-718-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 W COLLEGE DR
Provider Second Line Business Practice Location Address:
SUITE1NW
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-671-1374
Provider Business Practice Location Address Fax Number:
708-671-1378
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MANDREA
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
708-671-1374

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01604498 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com