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General NPI Number Information
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NPI Number | 1417341249
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Entity Type | Organization
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Legal Business Name | ALIVIO MEDICAL CENTER-JUAREZ HIGH SCHOOL
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 1450 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-4408
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Country | US
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Telephone | 773-254-1400
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Fax | 312-733-3563
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Provider Business Mailing Address
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Address Line | 2355 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-3837
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Country | US
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Telephone | 773-254-1400
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Fax | 312-733-3563
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. ESTHER CORPUZ
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Credential | C.E.O.
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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 | 771115088
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 771115008
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 771115088
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License Number State | IL
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