Basic Information
| Provider Information | |||||||||
| NPI: | 1184006397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBA | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| OtherLastName: | ALBA | ||||||||
| OtherFirstName: | MICHELE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5359 W FULLERTON AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606391450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738362785 | ||||||||
| FaxNumber: | 7738367381 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 23RD AVE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806346070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708102424 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2015 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R75303 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036147378 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.