Healthcare Provider Details

I. General information

NPI: 1538546791
Provider Name (Legal Business Name): MUSTAFA ALADIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 S CHICAGO ST
JOLIET IL
60436-3172
US

IV. Provider business mailing address

2025 S CHICAGO ST
JOLIET IL
60436-3172
US

V. Phone/Fax

Practice location:
  • Phone: 815-726-2200
  • Fax: 314-536-8783
Mailing address:
  • Phone: 815-726-2200
  • Fax: 314-536-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036148597
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036148597
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: