=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316111693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAA E ABDEL-MEGUID, M.D., S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N WALL ST SUITE 501
-----------------------------------------------------
City | KANKAKEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60901-2942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-937-9300
-----------------------------------------------------
Fax | 815-929-3951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 N WALL ST SUITE 501
-----------------------------------------------------
City | KANKAKEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60901-2942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-937-9300
-----------------------------------------------------
Fax | 815-929-3951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALAA EL-SAYED ABDEL-MEGUID
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 815-937-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------