Provider Demographics
NPI:1336322262
Name:JOSE A ALBISU MD
Entity Type:Organization
Organization Name:JOSE A ALBISU MD
Other - Org Name:CENTRO MEDICO DIGESTIVO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBISU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-277-3000
Mailing Address - Street 1:PO BOX 772970
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0270
Mailing Address - Country:US
Mailing Address - Phone:773-277-3000
Mailing Address - Fax:773-277-1035
Practice Address - Street 1:850 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3077
Practice Address - Country:US
Practice Address - Phone:773-277-3000
Practice Address - Fax:773-277-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075120207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6030101Medicaid
IL=========6030101Medicaid
IL949220Medicare PIN