Provider Demographics
NPI:1972512374
Name:HARNEY, ALFRED N (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:N
Last Name:HARNEY
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 1:2801 MATHERS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7064
Mailing Address - Country:US
Mailing Address - Phone:217-241-3586
Mailing Address - Fax:
Practice Address - Street 1:2801 MATHERS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7064
Practice Address - Country:US
Practice Address - Phone:217-241-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049350207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL008550OtherHEALTH ALLIANCE
ILCD7143OtherRR MEDICARE GROUP#
IL6394POtherCATERPILLAR
IL110201130OtherRR MEDICARE PIN
IL036049350OtherIL STATE LICENSE
IL08421024OtherBC/BS
IL14D0949277OtherCLIA
IL170767OtherPERSONAL CARE
IL036049350Medicaid
IL100577OtherHEALTHLINK
IL020057300OtherBLACK LUNG
IL133586700OtherACS-OWCP
ILD09930Medicare UPIN