Provider Demographics
NPI:1174861090
Name:ALVARADO, ALEXIS C (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:C
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8687 CONNECTICUT ST
Mailing Address - Street 2:STE D
Mailing Address - City:MERILLVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:46410-5541
Mailing Address - Country:US
Mailing Address - Phone:219-750-9630
Mailing Address - Fax:219-750-9451
Practice Address - Street 1:8687 CONNECTICUT ST
Practice Address - Street 2:STE D
Practice Address - City:MERILLVILLE
Practice Address - State:IL
Practice Address - Zip Code:46410-5541
Practice Address - Country:US
Practice Address - Phone:219-750-9630
Practice Address - Fax:219-750-9451
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-004592363AM0700X
IN10001662A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201235280Medicaid
INM67796003Medicare PIN