MEDICARE: ALFRED CISNEROS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-061744	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3160120373	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1144336173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED CISNEROS M.D.

Provider Business Mailing Address
First Line	:	4777 N HARLEM AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4658
Country	:	US
Telephone Number	:	708-867-4020
Fax Number	:	708-867-5306

Provider Business Practice Location Address
First Line	:	4777 N HARLEM AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4658
Country	:	US
Telephone Number	:	708-867-4020
Fax Number	:	708-867-5306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	03/07/2023

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