Provider Demographics
NPI:1669424230
Name:ALVAREZ, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:DEPT OF PSYCHIATRY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-955-8990
Mailing Address - Fax:414-955-6299
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:DEPT OF PSYCHIATRY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-955-8990
Practice Address - Fax:414-955-6299
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67008207R00000X, 2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1669424230Medicaid
LA1887919Medicaid
SC270450Medicaid