Provider Demographics
NPI:1043355670
Name:ROYA FAMILY MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:ROYA FAMILY MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-865-0663
Mailing Address - Street 1:PO BOX 5140
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-5140
Mailing Address - Country:US
Mailing Address - Phone:708-865-0663
Mailing Address - Fax:708-681-1812
Practice Address - Street 1:714 N BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-865-0663
Practice Address - Fax:708-681-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100953Medicaid
IL1626842OtherBCBS
IL036100953Medicaid
IL596790Medicare PIN