Provider Demographics
NPI:1598886368
Name:TAFUR, ALFONSO JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:JAVIER
Last Name:TAFUR
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 1:9650 GROSS POINT RD STE 4900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:847-663-8050
Mailing Address - Fax:224-251-4407
Practice Address - Street 1:9650 GROSS POINT RD STE 4900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-663-8050
Practice Address - Fax:224-251-4407
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137630207RC0000X
MN50994207R00000X
OK27674207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110012140Medicare PIN