Basic Information
Provider Information
NPI: 1467421677
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AGAPITO
FirstName: ARNOLD
MiddleName: V
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1005 HEALTH CENTER DR
Address2:  
City: MATTOON
State: IL
PostalCode: 619384693
CountryCode: US
TelephoneNumber: 2172386055
FaxNumber:  
Practice Location
Address1: 1000 HEALTH CENTER DR
Address2:  
City: MATTOON
State: IL
PostalCode: 619389261
CountryCode: US
TelephoneNumber: 2172582525
FaxNumber: 2172582216
Other Information
ProviderEnumerationDate: 03/17/2006
LastUpdateDate: 11/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X036-096352ILN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X036096352ILY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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