Provider Demographics
NPI:1629218235
Name:RIVERA, ANGEL LUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5215 N CALIFORNIA AVE
Mailing Address - Street 2:STE 603
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7014
Mailing Address - Country:US
Mailing Address - Phone:773-878-3627
Mailing Address - Fax:773-293-8824
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:LL7
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-878-8200
Practice Address - Fax:773-293-4197
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2016-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036126911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400268395Medicare PIN