Individual
DR. CLIVE LIONEL ALONZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 GRANT ST, GARY, IN 46402-6001
(773) 368-6395
Mailing address
11831 S BISHOP ST, CHICAGO, IL 60643-5013
(773) 368-6395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01060964A
IN
207R00000X
Internal Medicine Physician
036112177
IL
208M00000X
Hospitalist Physician
036112177
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000577319
ANTHEM
IN
05
—
200534280
—
IN
01
—
P00632889
MEDICARE RAILROAD
IN
01
—
P00664351
MEDICARE RAILROAD
IN
Enumeration date
01/31/2006
Last updated
09/22/2022
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