Individual
DR. NENITA IRABAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6250 S ARCHER AVE, CHICAGO, IL 60638-2639
(773) 581-8400
(773) 581-9577
Mailing address
6250 S ARCHER AVE, CHICAGO, IL 60638-2639
(773) 581-8400
(773) 581-9577
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36091558
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091558
—
IL
01
—
110129812
RAIL ROAD MEDICARE
IL
01
—
1607717
BC/BS OF ILLINOIS
IL
Enumeration date
03/23/2006
Last updated
01/21/2011
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