Healthcare Provider Details

I. General information

NPI: 1033042809
Provider Name (Legal Business Name): ALJAZI MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 N PONTIAC AVE
CHICAGO IL
60634-2849
US

IV. Provider business mailing address

3505 N PONTIAC AVE
CHICAGO IL
60634-2849
US

V. Phone/Fax

Practice location:
  • Phone: 312-610-2875
  • Fax: 908-279-0587
Mailing address:
  • Phone: 312-610-2875
  • Fax: 908-279-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KHADRA ALJAZI
Title or Position: NP/OWNER
Credential: DNP
Phone: 312-610-2875