Healthcare Provider Details

I. General information

NPI: 1124274311
Provider Name (Legal Business Name): ALIVIO MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 W CERMAK RD
CICERO IL
60804-2531
US

IV. Provider business mailing address

966 W 21ST ST
CHICAGO IL
60608-4511
US

V. Phone/Fax

Practice location:
  • Phone: 312-829-6304
  • Fax: 708-660-0349
Mailing address:
  • Phone: 773-254-1400
  • Fax: 312-829-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

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