Provider Demographics
NPI:1720229677
Name:ALVI MEDICAL SERVICES SC
Entity Type:Organization
Organization Name:ALVI MEDICAL SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SADNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-375-6500
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-0059
Mailing Address - Country:US
Mailing Address - Phone:815-725-1118
Mailing Address - Fax:815-725-1198
Practice Address - Street 1:2208 WEBER RD
Practice Address - Street 2:UNIT A
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0961
Practice Address - Country:US
Practice Address - Phone:815-725-1118
Practice Address - Fax:815-725-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1960Medicare PIN