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General NPI Number Information
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NPI Number | 1649441775
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Entity Type | Organization
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Legal Business Name | ALEXIS HEALTHCARE
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 5510 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60641-1330
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Country | US
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Telephone | 773-282-4700
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Fax | 773-282-4728
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Provider Business Mailing Address
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Address Line | 5510 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60641-1330
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Country | US
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Telephone | 773-282-4700
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Fax | 773-282-4728
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALBERT RALPH ROSANOVA JR.
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Credential | MD
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Telephone | 773-282-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036042670
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 036042670
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License Number State | IL
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