Provider Demographics
NPI:1861516023
Name:MENCHACA, ARTURO T (MD)
Entity type:Individual
Prefix:DR
First Name:ARTURO
Middle Name:T
Last Name:MENCHACA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2460
Mailing Address - Country:US
Mailing Address - Phone:217-465-8411
Mailing Address - Fax:217-463-3184
Practice Address - Street 1:727 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2460
Practice Address - Country:US
Practice Address - Phone:217-465-8411
Practice Address - Fax:217-463-3184
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060767207VX0201X, 208800000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No208800000XAllopathic & Osteopathic PhysiciansUrology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363610625OtherTAX ID
IL0021609821OtherBLUE CROSS BLUE SHEILD
IL363610625OtherTAX ID
ILD14757Medicare UPIN