Provider Demographics
NPI:1407267354
Name:ALENTA IMMEDIATE CARE, LLC
Entity Type:Organization
Organization Name:ALENTA IMMEDIATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-575-1066
Mailing Address - Street 1:2911 W MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2931
Mailing Address - Country:US
Mailing Address - Phone:773-575-1066
Mailing Address - Fax:
Practice Address - Street 1:3172 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6633
Practice Address - Country:US
Practice Address - Phone:773-575-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087269Medicaid