Healthcare Provider Details

I. General information

NPI: 1316111693
Provider Name (Legal Business Name): ALAA E ABDEL-MEGUID, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WALL ST SUITE 501
KANKAKEE IL
60901-2942
US

IV. Provider business mailing address

500 N WALL ST SUITE 501
KANKAKEE IL
60901-2942
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-9300
  • Fax: 815-929-3951
Mailing address:
  • Phone: 815-937-9300
  • Fax: 815-929-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: ALAA EL-SAYED ABDEL-MEGUID
Title or Position: OWNER
Credential: M.D.
Phone: 815-937-9300