Provider Demographics
NPI:1023085479
Name:PARRENO, XAVIER W (MD)
Entity type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:W
Last Name:PARRENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:135 N GREENLEAF ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3334
Mailing Address - Country:US
Mailing Address - Phone:847-336-2150
Mailing Address - Fax:847-336-2160
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3334
Practice Address - Country:US
Practice Address - Phone:847-336-2150
Practice Address - Fax:847-336-2160
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2017-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036097735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097735Medicaid
IL202117968OtherTAX ID #
IL14D1039883OtherCLIA
ILK18087OtherMCR PIN COOK COUNTY
IL4932456OtherBCBS
ILK18088OtherMCR PIN LAKE COUNTY
IL211782Medicare ID - Type UnspecifiedLAKE COUNTY
IL036097735Medicaid
IL14D1039883OtherCLIA