Provider Demographics
NPI:1841293032
Name:DE ALARCON, PEDRO A (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:DE ALARCON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S HOSPITAL OF IL 530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-655-4242
Mailing Address - Fax:309-655-2565
Practice Address - Street 1:CHILDREN'S HOSPITAL OF ILLINOIS 530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637
Practice Address - Country:US
Practice Address - Phone:309-655-4242
Practice Address - Fax:309-655-2565
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN382652080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME422400000Medicaid
MS09852769Medicaid
IN200113940AMedicaid
KY64081607Medicaid
OK200031030AMedicaid
MO209161306Medicaid
AR154138001Medicaid
TN5440121Medicaid
GA762912245AMedicaid
MS09852769Medicaid