Healthcare Provider Details

I. General information

NPI: 1710194477
Provider Name (Legal Business Name): MEDICOR PARTNERS, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6832 OGDEN AVE
BERWYN IL
60402-3643
US

IV. Provider business mailing address

5625 BENTLEY AVE
CLARENDON HILLS IL
60514-1509
US

V. Phone/Fax

Practice location:
  • Phone: 708-795-0890
  • Fax: 708-795-1521
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036085880
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036090919
License Number StateIL

VIII. Authorized Official

Name: MANUEL E ALVA
Title or Position: PHYSICIAN
Credential: MD
Phone: 630-325-2655