MEDICARE: MR. WILFREDO ROBERTO ALVARADO

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1821154691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILFREDO ROBERTO ALVARADO

Provider Business Mailing Address
First Line	:	4913 N AVERS AVE
Second Line	:	APARTMENT 2A
City	:	CHICAGO
State	:	IL
Zip	:	60625-6037
Country	:	US
Telephone Number	:	773-442-8155
Fax Number	:

Provider Business Practice Location Address
First Line	:	4913 N AVERS AVE
Second Line	:	APARTMENT 2A
City	:	CHICAGO
State	:	IL
Zip	:	60625-6037
Country	:	US
Telephone Number	:	773-442-8155
Fax Number	:

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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