1144538430 NPI number — DR. ALFRED LAMEE ALLEN MD

Table of content: DR. ALFRED LAMEE ALLEN MD (NPI 1144538430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144538430 NPI number — DR. ALFRED LAMEE ALLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
ALFRED
Provider Middle Name:
LAMEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMIN SHEHATA
Provider Other First Name:
ALFRED
Provider Other Middle Name:
LAMEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144538430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5201 WILLOW SPRINGS RD STE 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE HIGHLANDS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60525-6506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-972-5024
Provider Business Mailing Address Fax Number:
888-445-4214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5595 S OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINSDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60521-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-972-4437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036-132646 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8779088476 . This is a "MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: F400310767 . This is a "MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 20150720627853 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: F100277374 . This is a "MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: F400277380 . This is a "MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036132646 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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