Basic Information
| Provider Information | |||||||||
| NPI: | 1700872900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EGUES | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1918 W IRVING PARK RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606132408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739602555 | ||||||||
| FaxNumber: | 7734774478 | ||||||||
| Practice Location | |||||||||
| Address1: | 1918 W IRVING PARK RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606132408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734774900 | ||||||||
| FaxNumber: | 7734774478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 201026 | 01 | IL | ADVOCATE HEALTH PARTNERS | OTHER | 36444136901 | 01 | IL | ADVOCATE HEALTH CTR ID | OTHER | 01632128 | 01 | IL | BCBS | OTHER |