1669115150 NPI number — MR. IVAN DE LA RIVA MORALES M.D.

Table of content: MR. IVAN DE LA RIVA MORALES M.D. (NPI 1669115150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669115150 NPI number — MR. IVAN DE LA RIVA MORALES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA RIVA MORALES
Provider First Name:
IVAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
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:
1669115150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 E ONTARIO ST
Provider Second Line Business Mailing Address:
3205B
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-752-0788
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E HURON ST
Provider Second Line Business Practice Location Address:
MCGAW MEDICAL CENTER OF NORTHWESTERN UNIVERSITY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-926-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2022

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: 207ZP0102X , with the licence number:  125.079422 , 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)