MEDICARE: DR. MIGUEL JAEN ALCORDO 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	207K00000X	Allergy & Immunology Physician	036083285	IL
2	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	036083285	IL

General Provider Information

NPI Number	:	1477553899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL JAEN ALCORDO M.D.

Provider Business Mailing Address
First Line	:	16828 GREEN KNOLL AVE
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-5857
Country	:	US
Telephone Number	:	708-478-6093
Fax Number	:

Provider Business Practice Location Address
First Line	:	18210 LA GRANGE RD
Second Line	:	SUITE 201
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-7722
Country	:	US
Telephone Number	:	708-945-6328
Fax Number	:	708-478-1286

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/23/2025

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