Healthcare Provider Details

I. General information

NPI: 1386550978
Provider Name (Legal Business Name): AHMAD T ALLOULO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3834 N ASHLAND AVE
CHICAGO IL
60613-2766
US

IV. Provider business mailing address

5424 OLD ORCHARD RD APT 116
SKOKIE IL
60077-1177
US

V. Phone/Fax

Practice location:
  • Phone: 773-404-8030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037382
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: