Healthcare Provider Details

I. General information

NPI: 1275990061
Provider Name (Legal Business Name): ALEXIAN BROTHERS MEDICAL GROUP SPECIALTY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BIESTERFIELD RD UNIT 4D
ELK GROVE VILLAGE IL
60007-3309
US

IV. Provider business mailing address

701 BIESTERFIELD RD UNIT 4D
ELK GROVE VILLAGE IL
60007-3309
US

V. Phone/Fax

Practice location:
  • Phone: 855-692-6482
  • Fax:
Mailing address:
  • Phone: 855-692-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REINHOLD LLERENA
Title or Position: CEO
Credential:
Phone: 855-692-6482