Provider Demographics
NPI:1679623128
Name:AGUADO, BEATRICE (MD)
Entity type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:
Last Name:AGUADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BEA
Other - Middle Name:
Other - Last Name:AGUADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1919 S HIGHLAND AVE
Mailing Address - Street 2:115C
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6153
Mailing Address - Country:US
Mailing Address - Phone:630-639-6147
Mailing Address - Fax:
Practice Address - Street 1:1919 S HIGHLAND AVE
Practice Address - Street 2:115C
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6153
Practice Address - Country:US
Practice Address - Phone:630-639-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052045207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125052045OtherILLINOIS MEDICAL LICENSE