Healthcare Provider Details

I. General information

NPI: 1770739591
Provider Name (Legal Business Name): ALIVIO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 S KOSTNER AVE
CHICAGO IL
60623-4842
US

IV. Provider business mailing address

966 W 21ST ST
CHICAGO IL
60608-4511
US

V. Phone/Fax

Practice location:
  • Phone: 773-535-4291
  • Fax: 312-829-6842
Mailing address:
  • Phone: 773-254-1400
  • Fax: 773-829-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. ESTHER CORPUZ
Title or Position: CEO
Credential:
Phone: 312-829-6304