Healthcare Provider Details

I. General information

NPI: 1144516568
Provider Name (Legal Business Name): ALEXANDRA ISA ASROW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 111TH ST
CHICAGO IL
60628-4200
US

IV. Provider business mailing address

PO BOX 577641
CHICAGO IL
60657-7337
US

V. Phone/Fax

Practice location:
  • Phone: 773-995-3000
  • Fax:
Mailing address:
  • Phone: 847-207-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125-059688
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036135238
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number77728
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: