Provider Demographics
NPI:1518726082
Name:GARCIA, EMMANUEL JOSHUA MAGCALAS
Entity type:Individual
Prefix:
First Name:EMMANUEL JOSHUA
Middle Name:MAGCALAS
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 EDISON ST APT 12
Mailing Address - Street 2:
Mailing Address - City:JETMORE
Mailing Address - State:KS
Mailing Address - Zip Code:67854-9024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 E CHICAGO AVE # 3140W127
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4296
Practice Address - Country:US
Practice Address - Phone:312-503-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.083905207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty