Provider Demographics
NPI:1669558961
Name:AYUSTE, OFELIA (MD)
Entity type:Individual
Prefix:DR
First Name:OFELIA
Middle Name:
Last Name:AYUSTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4121 FAIRVIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2266
Mailing Address - Country:US
Mailing Address - Phone:630-971-8881
Mailing Address - Fax:630-971-8842
Practice Address - Street 1:4121 FAIRVIEW AVE STE 100
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2266
Practice Address - Country:US
Practice Address - Phone:630-971-8881
Practice Address - Fax:630-971-8842
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036065791208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics