Provider Demographics
NPI:1689626194
Name:TENCZAR, ALAN J
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:TENCZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:STE 214
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-594-9700
Mailing Address - Fax:773-594-0095
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:STE 214
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-594-9700
Practice Address - Fax:773-594-0095
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003540213ES0103X
IA00438213ES0103X
CAE3591213ES0103X
NE272213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0707390001OtherDMERC
ILCE8840OtherMEDICARE RR GROUP NUMBER
IL480020436OtherMEDICARE RR PROVIDER#
IL016003540Medicaid
IL60001380OtherBCBS OF ILLINOIS
ILCE8840OtherMEDICARE RR GROUP NUMBER
IL0707390001OtherDMERC
ILCE8840Medicare PIN
IL726711Medicare PIN
IL60001380OtherBCBS OF ILLINOIS