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General NPI Number Information
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NPI Number | 1487058731
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Entity Type | Organization
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Legal Business Name | ENCINAS MEDICAL CENTER
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 4614 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60609-3251
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Country | US
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Telephone | 773-888-2560
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Fax | 773-345-2560
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Provider Business Mailing Address
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Address Line | 3926 W TOUHY AVE SUITE 332
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1028
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Country | US
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Telephone | 773-888-2560
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Fax | 773-345-2560
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ALVARO ENCINAS
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Credential | M.D.
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Telephone | 773-888-2560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 042-620315
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License Number State | IL
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