Provider Demographics
NPI:1326290677
Name:ALONTO, EILEEN ANNE VICALDO (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN ANNE
Middle Name:VICALDO
Last Name:ALONTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EILEEN ANNE
Other - Middle Name:RIMANDO
Other - Last Name:VICALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 S DAMEN AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-569-6043
Mailing Address - Fax:312-569-8788
Practice Address - Street 1:820 S DAMEN AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-569-6043
Practice Address - Fax:701-234-7230
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12202207R00000X
IL036151087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16715Medicaid
NDN717550Medicare PIN
NDN715933Medicare PIN