1417230640 NPI number — OSCAR LINARES, M.D., P.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 1417230640 NPI number — OSCAR LINARES, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSCAR LINARES, M.D., P.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:
BERWYN PEDIATRICS
Provider Other Organization Name Type Code:
3
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:
1417230640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6545 CERMAK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERWYN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60402-2313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-788-0077
Provider Business Mailing Address Fax Number:
708-788-5620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6545 CERMAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-788-0077
Provider Business Practice Location Address Fax Number:
708-788-5620
Provider Enumeration Date:
09/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LINARES
Authorized Official First Name:
OSCAR
Authorized Official Middle Name:
ROBERTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-502-0414

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0600009078 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036087151 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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