Healthcare Provider Details

I. General information

NPI: 1487729257
Provider Name (Legal Business Name): ALEXANDER DOOLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON SUITE 810
CHICAGO IL
60612-3828
US

IV. Provider business mailing address

1725 W HARRISON SUITE 810
CHICAGO IL
60612-3828
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6500
  • Fax: 312-563-2080
Mailing address:
  • Phone: 312-942-6500
  • Fax: 312-563-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36039433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: