Provider Demographics
NPI:1881813855
Name:FERNANDEZ, ALEJANDRO MIGUEL (L AC --NMD)
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:MIGUEL
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:L AC --NMD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7773 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1736
Mailing Address - Country:US
Mailing Address - Phone:708-369-6498
Mailing Address - Fax:708-771-0868
Practice Address - Street 1:7773 LAKE ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1736
Practice Address - Country:US
Practice Address - Phone:708-369-6498
Practice Address - Fax:708-771-0868
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000431171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist