Individual
ALFREDO JOSE MENA LORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2875 W 19TH ST, CHICAGO, IL 60623
(773) 484-1000
Mailing address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(773) 484-1000
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
036129801
IL
208600000X
Surgery Physician
036129081
IL
390200000X
Student in an Organized Health Care Education/Training Program
125056547
IL
Other
Enumeration date
06/22/2009
Last updated
07/20/2021
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