Provider Demographics
NPI:1023034196
Name:ALVAREZ, VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 N RANDALL RD
Mailing Address - Street 2:STE 260
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9402
Mailing Address - Country:US
Mailing Address - Phone:847-931-7900
Mailing Address - Fax:847-931-1562
Practice Address - Street 1:1710 N RANDALL RD STE 260
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9402
Practice Address - Country:US
Practice Address - Phone:847-931-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229965207RC0200X, 207RP1001X
MDD65179207RC0200X, 207RP1001X
IL036-150072207RP1001X
NMMD2012-0867207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02751453Medicaid
NM41886046Medicaid
NM290390YPPRMedicare PIN
NY02751453Medicaid