Provider Demographics
NPI:1386850378
Name:XAVIER W. PARRENO, M.D., S.C.
Entity type:Organization
Organization Name:XAVIER W. PARRENO, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARRENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-336-2150
Mailing Address - Street 1:135 GREENLEAF ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3334
Mailing Address - Country:US
Mailing Address - Phone:847-336-2150
Mailing Address - Fax:847-336-2160
Practice Address - Street 1:135 GREENLEAF ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3334
Practice Address - Country:US
Practice Address - Phone:847-336-2150
Practice Address - Fax:847-336-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDF7056OtherRAILROAD MEDICARE
IL036097735Medicaid
ILH1050Medicare UPIN
IL036097735Medicaid
ILK18087Medicare PIN