Provider Demographics
NPI:1942488978
Name:DAVID, ALFONSO CHY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:CHY
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 EARLY BIRD LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-3794
Mailing Address - Country:US
Mailing Address - Phone:618-997-6937
Mailing Address - Fax:618-997-6937
Practice Address - Street 1:6665 STATE ROUTE 146 E
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-3122
Practice Address - Country:US
Practice Address - Phone:618-658-8331
Practice Address - Fax:618-658-4027
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine