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NPI Code Detail

MEDICARE: DR. MARIAN GISELLE ACEVEDO ALVAREZ MD

MEDICARE: DR. MARIAN GISELLE ACEVEDO ALVAREZ MD
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
1207V00000XObstetrics & Gynecology Physician053985CT
2390200000XStudent in an Organized Health Care Education/Training Program
3207VF0040XUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician036146956IL

General Provider Information

NPI Number : 1710271341
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIAN GISELLE ACEVEDO ALVAREZ MD
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-9000
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2011
Last Update Date : 10/25/2020

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