Healthcare Provider Details

I. General information

NPI: 1346314564
Provider Name (Legal Business Name): NADA ALDALLAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W 47TH ST
CHICAGO IL
60609-3833
US

IV. Provider business mailing address

1900 W 47TH ST
CHICAGO IL
60609-3833
US

V. Phone/Fax

Practice location:
  • Phone: 773-847-9004
  • Fax: 773-847-9008
Mailing address:
  • Phone: 773-847-9004
  • Fax: 773-847-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036104701
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number036104701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: