Provider Demographics
NPI:1780687640
Name:ALVARADO, ALEJANDRO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:J
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12860 TROXLER AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2898
Mailing Address - Country:US
Mailing Address - Phone:618-651-2810
Mailing Address - Fax:618-651-0077
Practice Address - Street 1:12860 TROXLER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2898
Practice Address - Country:US
Practice Address - Phone:618-651-2810
Practice Address - Fax:618-651-0077
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082478Medicaid
ILE81557Medicare UPIN
IL036082478Medicaid