MEDICARE: ENCINAS MEDICAL CENTER

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	261QP2300X	Primary Care Clinic/Center	042-620315	IL

General Provider Information

NPI Number	:	1487058731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCINAS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3926 W TOUHY AVE
Second Line	:	SUITE 332
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1028
Country	:	US
Telephone Number	:	773-888-2560
Fax Number	:	773-345-2560

Provider Business Practice Location Address
First Line	:	4614 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-3251
Country	:	US
Telephone Number	:	773-888-2560
Fax Number	:	773-345-2560

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ALVARO ENCINAS
Credential	:	M.D.
Telephone Number	:	773-888-2560

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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Directions to “ENCINAS MEDICAL CENTER ” Practice Location

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