Individual
ALAN FAVELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
333 MADISON ST, JOLIET, IL 60435-8200
(815) 741-7660
Mailing address
3303 W 26TH ST, CHICAGO, IL 60623-4036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.008265
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2020
Last updated
11/16/2021
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