Individual
DR. OSCAR LUIS ALONSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1121 WARREN AVE, STE 200, DOWNERS GROVE, IL 60515-3572
(630) 960-5310
(630) 969-7841
Mailing address
1121 WARREN AVE STE 200, DOWNERS GROVE, IL 60515-3572
(630) 960-5310
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036064967
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036064967
IL STATE LICENSE NUMBER
IL
05
—
036064967
—
IL
01
—
31602726
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/12/2006
Last updated
04/16/2021
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