Provider Demographics
NPI:1447220959
Name:PENA, ALVARO ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:ENRIQUE
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S YORK RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2631
Mailing Address - Country:US
Mailing Address - Phone:630-521-9700
Mailing Address - Fax:630-521-9797
Practice Address - Street 1:440 S YORK RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2631
Practice Address - Country:US
Practice Address - Phone:630-521-9700
Practice Address - Fax:630-521-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071431Medicaid
IL2222502OtherBCBS OF IL PROVIDER
461580Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL036071431Medicaid