Provider Demographics
NPI:1861758278
Name:AGUINALDO, EVARISTO PERALTA JR (MD)
Entity type:Individual
Prefix:DR
First Name:EVARISTO
Middle Name:PERALTA
Last Name:AGUINALDO
Suffix:JR
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 1:29 DEER PATH TRL
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6323
Mailing Address - Country:US
Mailing Address - Phone:630-655-3052
Mailing Address - Fax:
Practice Address - Street 1:16300 ILLINOIS 53
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403
Practice Address - Country:US
Practice Address - Phone:815-727-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-056945208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice