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General NPI Number Information
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NPI Number | 1124274311
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Entity Type | Organization
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Legal Business Name | ALIVIO MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 4842 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2531
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Country | US
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Telephone | 312-829-6304
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Fax | 708-660-0349
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Provider Business Mailing Address
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Address Line | 966 W 21ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-4511
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Country | US
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Telephone | 773-254-1400
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Fax | 312-829-6673
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Authorized Official
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Title or Position | CEO
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Name | MRS. ESTHER CORPUZ
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Credential |
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Telephone | 312-829-6304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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