Provider Demographics
NPI:1760613756
Name:ALMA COMPREHENSIVE MEDICAL CENTER, LTD
Entity Type:Organization
Organization Name:ALMA COMPREHENSIVE MEDICAL CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EVE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALEXANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-338-4700
Mailing Address - Street 1:1411 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-2128
Mailing Address - Country:US
Mailing Address - Phone:708-338-4700
Mailing Address - Fax:708-338-1931
Practice Address - Street 1:1411 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-2128
Practice Address - Country:US
Practice Address - Phone:708-338-4700
Practice Address - Fax:708-338-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049409Medicaid
IL036049409Medicaid