Provider Demographics
NPI:1316950033
Name:ESTRADA-GARCIA, DOLORES A (MD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:A
Last Name:ESTRADA-GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:AQUINO
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25228
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62525-5228
Mailing Address - Country:US
Mailing Address - Phone:217-329-3232
Mailing Address - Fax:217-233-1670
Practice Address - Street 1:210 W. MCKINLEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-876-6600
Practice Address - Fax:217-876-6606
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105214207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105214Medicaid
L86370Medicare PIN
0970490001Medicare NSC
IL036105214Medicaid