DR. JAVIER ANDRES TELLAGORRY (NPI# 1053544627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053544627 |
| Entity Type | Individual |
| Full Name | DR. JAVIER ANDRES TELLAGORRY |
| Credential | MD |
| Practice Address |
3331 W Deyoung St Suite 100 Marion IL 62959-5896 |
| Practice Telephone | 6189987600 |
| Practice Fax Number | 6189976680 |
| Mailing Telephone | 6189987600 |
| Mailing Fax Number | 6189976680 |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2016-10-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 036.141173 | IL | Other Service Providers |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
036141173 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
3331 W DEYOUNG ST SUITE 100 |
| City | MARION |
| State | IL |
| Zip Code | 62959-5896 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851394522 | Michael K Delaney | Otolaryngology | 3331 W Deyoung St, Ste 208, Marion, IL 62959-5897 | 2005-05-24 |
| 1275166134 | Heartland Rural Healthcare, LLC | Family Medicine | 3331 W Deyoung St, Marion, IL 62959-5896 | 2020-02-19 |
| 1356776645 | Tonia Swink | Nurse Practitioner | 3331 W Deyoung St, Marion, IL 62959-5896 | 2013-09-05 |
| 1467785014 | Angelito Dariel Tacderas | Nurse Practitioner | 3331 W Deyoung St, Ste 308, Marion, IL 62959-5896 | 2009-09-15 |
| 1205074093 | Allan C Gocio Md Neurosurgical Care, LLC | Neurological Surgery | 3331 W Deyoung St, Ste 308, Marion, IL 62959-5896 | 2009-02-02 |
| 1811194244 | Victor Mwansa | Internal Medicine | 3331 W Deyoung St, Suite 100, Marion, IL 62959-5896 | 2007-06-29 |
| 1992913669 | Marion Obstetrics & Gynecology, Ltd | Obstetrics & Gynecology | 3331 W Deyoung St, Suite 201, Marion, IL 62959-5896 | 2007-05-18 |
| 1114083169 | Southern Illinois Medical Care Associates, LLC | Family Medicine | 3331 W Deyoung St, Suite 305, Marion, IL 62959-5896 | 2006-12-27 |
| 1770646515 | M T Joseph | Internal Medicine | 3331 W Deyoung St, Ste 100, Marion, IL 62959-5896 | 2006-12-19 |
| 1316009582 | Heartland Rural Healthcare, LLC | Family Medicine | 3331 W Deyoung St, Suite 207, Marion, IL 62959-5896 | 2006-12-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710513486 | Sarah Benitone | Counselor | 11264 Il-37, Marion, IL 62959 | 2020-03-13 |
| 1528609328 | Patricia E Murphy | Radiology | 4503 1/2 W Deyoung, Suite 3a, Marion, IL 62959 | 2019-10-02 |
| 1366007007 | Centerstone of Illinois, Inc | Community/Behavioral Health | 202 S Bentley St, Marion, IL 62959 | 2019-05-08 |
| 1649752064 | Sydney Seiter | Occupational Therapist | 906 Skyline Suite 100, Marion, IL 62959 | 2018-09-01 |
| 1497279848 | Brooke Alisa Osman | Licensed Practical Nurse | 11531 Sunderland Road, Marion, IL 62959 | 2017-07-27 |
| 1912436429 | Joy L. Kee | Social Worker | 509 South Bentley Street, Marion, IL 62959 | 2017-06-08 |
| 1386181170 | Susan Smothers | Counselor | 1305 West Main Street, Marion, IL 62959 | 2017-01-31 |
| 1205280922 | Harish Kempegowda | Orthopaedic Surgery | 3331 W Deyoung St Ste 201, Marion, IL 62959 | 2016-04-19 |
| 1942609227 | Casey Hill | Social Worker | 1604 W. Walnut St., Marion, IL 62959 | 2014-08-22 |
| 1306252812 | Justin M White | Chiropractor | 1603 W Kimmel, Marion, IL 62959 | 2014-07-03 |
| Find all providers in zip 62959 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396267324 | Congress Vascular Center LLC | Surgery | 41 W Congress Pkwy Fl 1, Chicago, IL 60605-1531 | 2017-07-11 |
| 1043731300 | Elmwood Park Vascular Center LLC | Surgery | 7230 W North Ave Ste 108, Elmwood Park, IL 60707-4261 | 2017-06-27 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1992126668 | Vascular Specialists LLC | Surgery | 20060 Governors Dr Ste 102, Olympia Fields, IL 60461-1099 | 2013-12-26 |
| 1588959548 | Patrick Michael Sullivan Neville | Surgery | 4600 Memorial Dr Ste 120, Belleville, IL 62226-5359 | 2011-06-17 |
| 1235454968 | Margaret Claire Rigamer | Surgery | 1901 W Harrison St Dept Of, Chicago, IL 60612-3714 | 2010-04-06 |
| 1215251541 | John V. White, Md, LLC | Surgery | 8816 W Dempster St, Niles, IL 60714-5109 | 2010-03-15 |
| 1710212733 | Vascular Surgery and Interpretation S.c. | Surgery | 3330 W 177th St Ste 2c1, Hazel Crest, IL 60429-2184 | 2009-10-08 |
| 1538391792 | Usa Vein Clinics of Chicago LLC | Surgery | 4141 Dundee Rd, Northbrook, IL 60062-2129 | 2009-08-20 |
| 1306010731 | Tanq, Inc. | Surgery | 18510 S Marilynn Ct, Mokena, IL 60448-9517 | 2008-04-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.