Amando a Reniva MDSC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036105799 Issued in IL

Legal business name

AMANDO A RENIVA MDSC

Doing business as

PRIMARY CARE SKOKIE

Practice address

6315 N Milwaukee Ave # a
Chicago, IL 60646-3760

Phone

(847) 698-0661

Fax

(847) 768-9132

NPI assigned

Nov 13, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amando A Reniva, MD

Title

President

Phone

(847) 698-0661

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• PRIMARY CARE SKOKIE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464998400000",
    "number": "1639323942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 S WASHINGTON AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684814",
            "telephone_number": "773-551-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6315 N MILWAUKEE AVE # A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606463760",
            "telephone_number": "847-698-0661",
            "fax_number": "847-768-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANDO A RENIVA MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-13",
        "last_updated": "2016-06-04",
        "status": "A",
        "authorized_official_last_name": "RENIVA",
        "authorized_official_first_name": "AMANDO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-698-0661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036105799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP",
            "identifier": "1639323942",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "207202",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID #",
            "identifier": "K01460",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1932109352",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIMARY CARE SKOKIE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.