Healthcare Provider Details

I. General information

NPI: 1407231913
Provider Name (Legal Business Name): ISSA ALHAMOUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

IV. Provider business mailing address

120 E OGDEN AVE STE 204
HINSDALE IL
60521-3546
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5437
  • Fax: 708-876-1569
Mailing address:
  • Phone: 214-449-3159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD-47190
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-47190
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number036-159245
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: