Provider Demographics
NPI:1104885466
Name:IRABAGON, NENITA (MD)
Entity type:Individual
Prefix:DR
First Name:NENITA
Middle Name:
Last Name:IRABAGON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2639
Mailing Address - Country:US
Mailing Address - Phone:773-581-8400
Mailing Address - Fax:773-581-9577
Practice Address - Street 1:6250 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2639
Practice Address - Country:US
Practice Address - Phone:773-581-8400
Practice Address - Fax:773-581-9577
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36091558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110129812OtherRAIL ROAD MEDICARE
IL1607717OtherBC/BS OF ILLINOIS
IL036091558Medicaid
IL110129812OtherRAIL ROAD MEDICARE
IL036091558Medicaid