1639219900 NPI number — MRS. ALISON NICOLE SOLTIS MOT OTRL

Table of content: MRS. ALISON NICOLE SOLTIS MOT OTRL (NPI 1639219900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639219900 NPI number — MRS. ALISON NICOLE SOLTIS MOT OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLTIS
Provider First Name:
ALISON
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MOT OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOLTIS
Provider Other First Name:
ALISON
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MOT OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639219900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14785 LAKEVIEW DR
Provider Second Line Business Mailing Address:
#103
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-590-6455
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19065 HICKORY CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOKENA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-478-5400
Provider Business Practice Location Address Fax Number:
708-478-5300
Provider Enumeration Date:
02/07/2007

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: 225X00000X , 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)





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