Healthcare Provider Details

I. General information

NPI: 1083861686
Provider Name (Legal Business Name): ALPHA MED PHYSICIANS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 S HARLEM AVE
PALOS HEIGHTS IL
60463-1435
US

IV. Provider business mailing address

12150 S HARLEM AVE
PALOS HEIGHTS IL
60463-1435
US

V. Phone/Fax

Practice location:
  • Phone: 708-361-4778
  • Fax: 708-361-4799
Mailing address:
  • Phone: 708-361-4778
  • Fax: 708-361-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: S. JAVED SHIRAZI
Title or Position: MANAGER
Credential: M.D.
Phone: 708-361-4778