Provider Demographics
NPI:1386897700
Name:ALVAREZ, SUSANA CORALIA (MD)
Entity type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:CORALIA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SUSANA
Other - Middle Name:CORALIA
Other - Last Name:ALVAREZ-BANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13000 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2318
Mailing Address - Country:US
Mailing Address - Phone:708-385-6100
Mailing Address - Fax:708-385-2051
Practice Address - Street 1:13000 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2318
Practice Address - Country:US
Practice Address - Phone:708-385-6100
Practice Address - Fax:708-385-2051
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122436208000000X
IN01051236A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN