MEDICARE: DR. ALEXANDER TAIKWEL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036176030	IL

General Provider Information

NPI Number	:	1255073565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER TAIKWEL DO

Provider Business Mailing Address
First Line	:	1460 N HALSTED ST STE 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2613
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:	312-926-3231

Provider Business Practice Location Address
First Line	:	1460 N HALSTED ST STE 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2613
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:	312-926-3231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	12/04/2025

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