Provider Demographics
NPI:1962426239
Name:GERMINO, F. WILFORD (MD)
Entity type:Individual
Prefix:DR
First Name:F.
Middle Name:WILFORD
Last Name:GERMINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:16660 S. 107TH AVE.
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-403-8500
Practice Address - Fax:708-364-7080
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0991123OtherCLIA #
IL4082441OtherAETNA PROVIDER ID#
IL705600OtherMEDICARE GROUP #
IL036062103Medicaid
IL01630151OtherBCBS PROVIDER GROUP #
IL14D0991123OtherCLIA #