Provider Demographics
NPI:1952291726
Name:MENA PENAFIEL, ALEXIS FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:FERNANDO
Last Name:MENA PENAFIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2312
Mailing Address - Country:US
Mailing Address - Phone:708-783-6566
Mailing Address - Fax:
Practice Address - Street 1:3722 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2312
Practice Address - Country:US
Practice Address - Phone:708-783-6566
Practice Address - Fax:708-783-6567
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.085557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine