MEDICARE: ILLINOIS PHYSICIANS ALLIANCE, LLC

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1457708216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS PHYSICIANS ALLIANCE, LLC

Provider Business Mailing Address
First Line	:	3445 N CENTRAL AVE UNIT C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 N CENTRAL AVE UNIT C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4420
Country	:	US
Telephone Number	:	773-205-0800
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HARESH SAWLANI
Credential	:
Telephone Number	:	773-205-0800

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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