Healthcare Provider Details

I. General information

NPI: 1659973964
Provider Name (Legal Business Name): LUTFI ALKADDOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WESTBROOK CORPORATE CTR STE 300
WESTCHESTER IL
60154-5709
US

IV. Provider business mailing address

1 WESTBROOK CORPORATE CTR STE 300
WESTCHESTER IL
60154-5709
US

V. Phone/Fax

Practice location:
  • Phone: 708-566-6205
  • Fax:
Mailing address:
  • Phone: 708-566-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: