Individual
HELIODORO MEDINA
Active
Individual
HELIODORO MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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