Provider Demographics
NPI:1750538104
Name:ADOLFO M. MAGLAYA, M.D., S.C.
Entity type:Organization
Organization Name:ADOLFO M. MAGLAYA, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:MORI
Authorized Official - Last Name:MAGLAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-846-4800
Mailing Address - Street 1:326 W. 64TH ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621
Mailing Address - Country:US
Mailing Address - Phone:773-846-4800
Mailing Address - Fax:
Practice Address - Street 1:326 W. 64TH ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621
Practice Address - Country:US
Practice Address - Phone:773-846-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-045274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-045274Medicaid
IL036-045274Medicaid