Individual
DR. AMANDO A RENIVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6315 N MILWAUKEE AVE # A, CHICAGO, IL 60646-3760
(847) 679-1668
Mailing address
1125 S WASHINGTON AVE, PARK RIDGE, IL 60068-4814
(847) 698-0661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036105799
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105799
—
IL
01
—
1932109352
NPI INDIVIDUAL
—
01
—
K01460
MEDICARE ID #
—
Enumeration date
07/28/2005
Last updated
06/04/2016
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