Healthcare Provider Details

I. General information

NPI: 1477553899
Provider Name (Legal Business Name): MIGUEL JAEN ALCORDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18210 LA GRANGE RD SUITE 201
TINLEY PARK IL
60487-7722
US

IV. Provider business mailing address

16828 GREEN KNOLL AVE
ORLAND PARK IL
60467-5857
US

V. Phone/Fax

Practice location:
  • Phone: 708-945-6328
  • Fax: 708-478-1286
Mailing address:
  • Phone: 708-478-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036083285
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number036083285
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: