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NPI 1710194477

NPI 1710194477 : MEDICOR PARTNERS, S.C : BERWYN, IL

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General NPI Number Information
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    NPI Number           |    1710194477
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    Entity Type          |    Organization 
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    Legal Business Name  |    MEDICOR PARTNERS, S.C 
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Dates
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    Enumeration Date     |    05/16/2007
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    Last Update Date     |    09/21/2023
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Provider Practice Location Address
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    Address Line         |    6832 OGDEN AVE 
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    City                 |    BERWYN
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    State                |    IL
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    Zip                  |    60402-3643
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    Country              |    US
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    Telephone            |    708-795-0890
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    Fax                  |    708-795-1521
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Provider Business Mailing Address
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    Address Line         |    5625 BENTLEY AVE 
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    City                 |    CLARENDON HILLS
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    State                |    IL
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    Zip                  |    60514-1509
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    PHYSICIAN
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    Name                 |     MANUEL E ALVA 
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    Credential           |    MD
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    Telephone            |    630-325-2655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    207RI0200X
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    Taxonomy Name        |    Infectious Disease Physician
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    License Number       |    036090919
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    License Number State |    IL
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Taxonomy #2
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    Taxonomy Code        |    207RG0100X
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    Taxonomy Name        |    Gastroenterology Physician
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    License Number       |    036085880
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    License Number State |    IL
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