Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036-101645 | IL |
Y | 208000000X | Pediatrician | 036101645 | IL |
NPI | 1003816588 |
---|---|
Provider Name | Dr. Suraiya I Alvi |
First Address | Chicago, IL 60674-0035 |
Second Address | Chicago, IL 60608-1732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 27/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-101645-1 | (05) | IL |
C34056 | (02) | IL |