MEDICARE: ALTEA MEDICAL ILLINOIS PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207QA0505X	Adult Medicine Physician
3	208100000X	Physical Medicine & Rehabilitation Physician
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1447039227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTEA MEDICAL ILLINOIS PLLC

Provider Business Mailing Address
First Line	:	400 E RIVULON BLVD STE 103
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-0096
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 W 16TH PL
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3224
Country	:	US
Telephone Number	:	888-408-7008
Fax Number	:

Authorized Official
Title or Position	:	VP OF REVENUE CYCLE
Name	:	LISA KRUEGER
Credential	:
Telephone Number	:	888-408-7008

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	11/17/2025

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