1447285739 NPI number — DR. OSCAR LUIS ALONSO M.D.

Table of content: DR. OSCAR LUIS ALONSO M.D. (NPI 1447285739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447285739 NPI number — DR. OSCAR LUIS ALONSO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALONSO
Provider First Name:
OSCAR
Provider Middle Name:
LUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447285739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 WARREN AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-960-5310
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 WARREN AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-960-5310
Provider Business Practice Location Address Fax Number:
630-969-7841
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  036064967 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31602726 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036064967 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036064967 . This is a "IL STATE LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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