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Individual

JESUS AQUINO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2911 SYCAMORE RD, DEKALB, IL 60115-9205
(815) 756-1521
Mailing address
PO BOX 2184, INDIANAPOLIS, IN 46206-2184

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036045080
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036045080
IL
01
1922250
BCBS IL
IL
01
P00239914
RAILROAD MEDICARE
Enumeration date
10/20/2006
Last updated
07/30/2010
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