Basic Information
| Provider Information | |||||||||
| NPI: | 1164412656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKS | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AKS | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1239 E MAIN ST | ||||||||
| Address2: | P O BOX 3988 | ||||||||
| City: | CARBONDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629013114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184575200 | ||||||||
| FaxNumber: | 6183514821 | ||||||||
| Practice Location | |||||||||
| Address1: | 1237 E MAIN SUITE C1 | ||||||||
| Address2: | THE BREAST CENTER UNIVERSITY MALL | ||||||||
| City: | CARBONDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629013114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184572281 | ||||||||
| FaxNumber: | 6185290573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 02/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | CA009351 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 306126874 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4124481 | 05 | MI | MEDICAID | 134360 | 01 | MI | CARE CHOICES | OTHER | 020044482 | 01 | MI | RAILROAD MEDICARE | OTHER | 036126874 | 05 | IL | MEDICAID | 14797 | 01 | MI | MCARE | OTHER | 258213724 | 01 | MI | BCBS | OTHER | HAP | 01 | MI | E83433 | OTHER | 020H232520 | 01 | MI | BCBSM | OTHER |