Healthcare Provider Details

I. General information

NPI: 1467741314
Provider Name (Legal Business Name): ALPHA MED PHYSICIANS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17333 S LAGRANGE RD SUITE 200
TINLEY PARK IL
60487-7581
US

IV. Provider business mailing address

17333 S LAGRANGE RD SUITE 200
TINLEY PARK IL
60487-7581
US

V. Phone/Fax

Practice location:
  • Phone: 708-342-1900
  • Fax: 708-745-9993
Mailing address:
  • Phone: 708-342-1900
  • Fax: 708-745-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SUBRAMANYA RAO
Title or Position: MANAGER
Credential: M.D.
Phone: 708-342-1900