Provider Demographics
NPI:1588789309
Name:TADO, SELENA KAY (LPT)
Entity type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:KAY
Last Name:TADO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 QUEENSBURY CT
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6512
Mailing Address - Country:US
Mailing Address - Phone:224-333-0384
Mailing Address - Fax:847-669-6190
Practice Address - Street 1:10436 ROUTE 47
Practice Address - Street 2:SUITE 105
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:847-515-3366
Practice Address - Fax:847-515-3356
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL140176Medicare Oscar/Certification