Healthcare Provider Details

I. General information

NPI: 1407387962
Provider Name (Legal Business Name): RAFEL AL-HIALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAFEL H. ABDULRAHMAN ALHIALI MD

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-5424
  • Fax: 773-296-5265
Mailing address:
  • Phone: 773-296-5424
  • Fax: 773-296-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA169740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: