Active NPI
Alejandro Javier Nieto Dominguez, M.D.
- Internal Medicine Physician
- Chicago, IL
National Provider Identifier
1114665049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 125079892
- Practice address
- 1901 W. Harrison
Chicago, IL 60612-3714 - Phone
- (312) 864-6000
- NPI assigned
- May 20, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 125079892 | IL | Primary |
Addresses
Primary practice location
1901 W. Harrison
Chicago, IL 60612-3714
Mailing address
1922 W. Ogden Ave
Unit 0714
Chicago, IL 60612
Phone (312) 826-3254
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125079892 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664409600000",
"number": "1114665049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1922 W. OGDEN AVE",
"address_2": "UNIT 0714",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-826-3254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 W. HARRISON",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123714",
"telephone_number": "312-864-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIETO DOMINGUEZ",
"first_name": "ALEJANDRO",
"middle_name": "JAVIER",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-20",
"last_updated": "2022-09-29",
"certification_date": "2022-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125079892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.