Basic Information
| Provider Information | |||||||||
| NPI: | 1326535253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRICENO BIERWIRTH | ||||||||
| FirstName: | ADRIANA | ||||||||
| MiddleName: | CAROLINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17800 KEDZIE AVE | ||||||||
| Address2: | |||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087302200 | ||||||||
| FaxNumber: | 7082100625 | ||||||||
| Practice Location | |||||||||
| Address1: | 17800 KEDZIE AVE | ||||||||
| Address2: | |||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087302200 | ||||||||
| FaxNumber: | 7082100625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2018 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-155925 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.