Healthcare Provider Details

I. General information

NPI: 1548668148
Provider Name (Legal Business Name): YASEEN ALKADDOUMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 108
ORLAND PARK IL
60462-4685
US

IV. Provider business mailing address

15300 WEST AVE STE 108
ORLAND PARK IL
60462-4685
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-2318
  • Fax: 708-226-2319
Mailing address:
  • Phone: 708-226-2318
  • Fax: 708-226-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.066101
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01085436A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01085436A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036142341
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: