Provider Demographics
NPI:1699039545
Name:GROVE DE ALENCAR, AMBER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LYNN
Last Name:GROVE DE ALENCAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2606
Mailing Address - Country:US
Mailing Address - Phone:708-383-0113
Mailing Address - Fax:708-383-9911
Practice Address - Street 1:14 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2606
Practice Address - Country:US
Practice Address - Phone:708-383-0113
Practice Address - Fax:708-383-9911
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125061846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine