Provider Demographics
NPI:1124314950
Name:ARTUNDUAGA, MARIA ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEXANDRA
Last Name:ARTUNDUAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA ALEXANDRA
Other - Middle Name:
Other - Last Name:ARTUNDUAGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 6035
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 6035
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-795-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060147208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery