Provider Demographics
NPI:1710120696
Name:ALLIANCE INTERNAL MEDICINE, S.C.
Entity Type:Organization
Organization Name:ALLIANCE INTERNAL MEDICINE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAW
Authorized Official - Middle Name:M
Authorized Official - Last Name:OO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-523-2070
Mailing Address - Street 1:370 LARRY POWER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5193
Mailing Address - Country:US
Mailing Address - Phone:815-523-7020
Mailing Address - Fax:815-523-7022
Practice Address - Street 1:370 LARRY POWER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-523-2070
Practice Address - Fax:815-523-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090440207R00000X
IL036108040207R00000X
IL036090542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108040OtherSAW OO, M.D.
IL036090542OtherJOEL VILLEGAS, M.D
IL036090440OtherDR. CHANDAN D.O.
IL036090440OtherDR. CHANDAN D.O.
IL2309Medicare UPIN