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Organization
AMANDO A RENIVA MDSC
Active
Organization
AMANDO A RENIVA MDSC
Active
Other names
PRIMARY CARE SKOKIE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMANDO A RENIVA MD (PRESIDENT)
(847) 698-0661
Entity
Organization
Contact information
Practice address
6315 N MILWAUKEE AVE # A, CHICAGO, IL 60646-3760
(847) 698-0661
(847) 768-9132
Mailing address
1125 S WASHINGTON AVE, PARK RIDGE, IL 60068-4814
(773) 551-3570
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036105799
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639323942
NPI GROUP
—
01
—
1932109352
INDIVIDUAL NPI NUMBER
IL
01
—
207202
MEDICARE PTAN
—
01
—
K01460
MEDICARE ID #
—
Enumeration date
11/13/2008
Last updated
06/04/2016
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