MEDICARE: MIGUEL ENRIQUE MANRIQUE PALAVICCINI 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
1	207RN0300X	Nephrology Physician	036.174840	IL
2	207R00000X	Internal Medicine Physician	125081021	IL

General Provider Information

NPI Number	:	1831821099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL ENRIQUE MANRIQUE PALAVICCINI MD

Provider Business Mailing Address
First Line	:	3616 W WILSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 W WILSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8159
Country	:	US
Telephone Number	:	224-409-0423
Fax Number	:

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

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/10/2025

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