Healthcare Provider Details

I. General information

NPI: 1700047917
Provider Name (Legal Business Name): FATIMA ALAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMA DOMINGUEZ TRINIDAD

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DR STE 107
MATTOON IL
61938-4644
US

IV. Provider business mailing address

PO BOX 372
MATTOON IL
61938-0372
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-4096
  • Fax: 217-238-5485
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036-133771
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036133771
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: