Healthcare Provider Details

I. General information

NPI: 1386670941
Provider Name (Legal Business Name): NAZEM ALZALAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9830 RIDGELAND AVE STE 2
CHICAGO RIDGE IL
60415-2668
US

IV. Provider business mailing address

8550 S HARLEM AVE STE B
BRIDGEVIEW IL
60455-1775
US

V. Phone/Fax

Practice location:
  • Phone: 708-599-8000
  • Fax: 708-599-8006
Mailing address:
  • Phone: 708-599-8000
  • Fax: 888-383-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036087470
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: