Individual
DR. ARSENIA M NEPOMUCENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1712 LYNWOOD CT, FLOSSMOOR, IL 60422-1932
(708) 957-7187
Mailing address
1712 LYNWOOD CT, FLOSSMOOR, IL 60422-1932
(708) 957-7187
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036069960
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069960
—
IL
01
—
1124322680
GROUP NPI
IL
01
—
364317999
TAX ID
IL
01
—
806290
MEDICARE GROUP PTAN
IL
01
—
IL5686007
MEDICARE PTAN
IL
Enumeration date
11/10/2005
Last updated
12/13/2024
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