Provider Demographics
NPI:1154388460
Name:AGUILAR, ABEL R (DPM)
Entity type:Individual
Prefix:DR
First Name:ABEL
Middle Name:R
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 W CABER CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-7906
Mailing Address - Country:US
Mailing Address - Phone:518-339-8086
Mailing Address - Fax:
Practice Address - Street 1:1416 W CABER CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-7906
Practice Address - Country:US
Practice Address - Phone:518-339-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001035A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000523734OtherANTHEM
IN200854430Medicaid
NY02608033Medicaid
783861OtherMVP
PJ5781OtherBCBS
INP00387091Medicare PIN
783861OtherMVP
V01564Medicare UPIN
IN200854430Medicaid