Provider Demographics
NPI:1710003710
Name:SANCHEZ, ALEJANDRO
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:SANCHEZ
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 1:1901 WEST HARRISON
Mailing Address - Street 2:FANTUS/ASC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-864-0706
Mailing Address - Fax:312-689-3258
Practice Address - Street 1:1901 WEST HARRISON
Practice Address - Street 2:FANTUS/ASC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-864-0706
Practice Address - Fax:312-689-3258
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85-000433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPO3486Medicare UPIN