Provider Demographics
NPI:1376730473
Name:TEODORO A ALVIA MD SC
Entity type:Organization
Organization Name:TEODORO A ALVIA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-519-0500
Mailing Address - Street 1:990 GRAND CANYON PKWY STE 415
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:990 GRAND CANYON PKWY STE 415
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1731
Practice Address - Country:US
Practice Address - Phone:847-519-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01623255OtherBCBS
IL036049412Medicaid
ILDG8903OtherRAIL ROAD MEDICARE
D12836Medicare UPIN
IL208273Medicare PIN