Provider Demographics
NPI:1265606131
Name:NAVARES, ALEXIS BERTUMEN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:BERTUMEN
Last Name:NAVARES
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MICHAEL AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099
Mailing Address - Country:US
Mailing Address - Phone:847-917-9197
Mailing Address - Fax:
Practice Address - Street 1:655 ROCKLAND RD
Practice Address - Street 2:STE 206
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044
Practice Address - Country:US
Practice Address - Phone:847-283-0720
Practice Address - Fax:847-283-0723
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant