Individual
HELIODORO MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
302 RANDALL RD, GENEVA, IL 60134-4220
(630) 262-7400
(630) 262-3760
Mailing address
302 RANDALL RD, GENEVA, IL 60134-4220
(630) 262-7400
(630) 262-3760
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036104186
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100061
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
CA4748
RAILROAD MEDICARE (GROUP PTAN)
IL
01
—
F400100146
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P01248201
RAILROAD MEDICARE (PROVIDER PTAN)
IL
Enumeration date
12/30/2005
Last updated
03/04/2015
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