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General NPI Number Information
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NPI Number | 1336272913
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Entity Type | Individual
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Provider Name | JOSE ANTONIO ALBISU M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 850 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-3077
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Country | US
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Telephone | 847-858-2821
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 772970
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City | CHICAGO
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State | IL
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Zip | 60677-0270
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Country | US
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Telephone | 847-858-2821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036075120
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License Number State | IL
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