Healthcare Provider Details

I. General information

NPI: 1841932357
Provider Name (Legal Business Name): ALAA HAJEISSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST STE 720
PEORIA IL
61602-5027
US

IV. Provider business mailing address

2327 S SACRAMENTO AVE UNIT 1
CHICAGO IL
60623-3462
US

V. Phone/Fax

Practice location:
  • Phone: 734-604-3618
  • Fax:
Mailing address:
  • Phone: 734-604-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberW2725
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: