Provider Demographics
NPI:1275990061
Name:ALEXIAN BROTHERS MEDICAL GROUP SPECIALTY CARE
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS MEDICAL GROUP SPECIALTY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REINHOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:LLERENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-692-6482
Mailing Address - Street 1:2380 E DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4839
Mailing Address - Country:US
Mailing Address - Phone:855-692-6482
Mailing Address - Fax:
Practice Address - Street 1:2380 E DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4839
Practice Address - Country:US
Practice Address - Phone:855-692-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty