MEDICARE: ALIVIO MEDICAL CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	261QS1000X	Student Health Clinic/Center
2	208D00000X	General Practice Physician	IL
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1629478359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIVIO MEDICAL CENTER

Provider Business Mailing Address
First Line	:	966 W 21ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4511
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:	312-829-6842

Provider Business Practice Location Address
First Line	:	1450-1510 W. CERMAK ROAD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ANKIT PATEL
Credential	:
Telephone Number	:	312-312-2719

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	04/22/2026

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Directions to “ALIVIO MEDICAL CENTER ” Practice Location

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