Healthcare Provider Details

I. General information

NPI: 1649331646
Provider Name (Legal Business Name): ALAN I NEWMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 N NORTH BRANCH ST SUITE 210
CHICAGO IL
60642-2473
US

IV. Provider business mailing address

6836 S CRANDON AVE UNIT 1
CHICAGO IL
60649-1251
US

V. Phone/Fax

Practice location:
  • Phone: 312-939-5090
  • Fax: 312-640-4496
Mailing address:
  • Phone: 773-493-8126
  • Fax: 773-493-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-066944
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: