Healthcare Provider Details

I. General information

NPI: 1760625867
Provider Name (Legal Business Name): ALPHA MED PHYSICIANS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17333 LA GRANGE RD SUITE 200
TINLEY PARK IL
60487-7502
US

IV. Provider business mailing address

17333 LA GRANGE RD SUITE 200
TINLEY PARK IL
60487-7502
US

V. Phone/Fax

Practice location:
  • Phone: 708-342-1900
  • Fax: 708-429-3175
Mailing address:
  • Phone: 708-342-1900
  • Fax: 708-429-3175

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: M. MUFADDAL HAMADEH
Title or Position: MANAGER
Credential: MD
Phone: 708-342-1900