Basic Information
| Provider Information | |||||||||
| NPI: | 1023059748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACAGBA | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20201 CRAWFORD AVE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085033857 | ||||||||
| FaxNumber: | 7085033806 | ||||||||
| Practice Location | |||||||||
| Address1: | 20201 CRAWFORD AVE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085033857 | ||||||||
| FaxNumber: | 7085033806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 036059682 | IL | N | Other Service Providers | Specialist | 207L00000X | 036059682 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.