Healthcare Provider Details

I. General information

NPI: 1790218469
Provider Name (Legal Business Name): ALEXIS SERRANO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2017
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 210
ORLAND PARK IL
60462-4686
US

IV. Provider business mailing address

508 N ALEXANDER ST
PLANT CITY FL
33563-3036
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-2870
  • Fax: 708-226-2315
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS19641
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036171309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: