Provider Demographics
NPI:1255405452
Name:ALVA, MANUEL E (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:E
Last Name:ALVA
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 1:5625 BENTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1509
Mailing Address - Country:US
Mailing Address - Phone:630-325-2655
Mailing Address - Fax:630-325-2993
Practice Address - Street 1:6832 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3643
Practice Address - Country:US
Practice Address - Phone:708-795-0890
Practice Address - Fax:708-795-1521
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036085880207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12259OtherAMERIGROUP
IL036085880Medicaid
IL2232097OtherBLUE CROSS BLUE SHIELD
ILP00472782OtherRAILROAD MEDICARE
IL2232097OtherBLUE CROSS BLUE SHIELD
IL036085880Medicaid
IL204376Medicare ID - Type Unspecified