=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356035182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIF SPINE ACCESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2023
-----------------------------------------------------
Last Update Date | 06/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 183 N ADDISON AVE APT 411
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-3198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-952-4998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 183 N ADDISON AVE APT 411
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-3198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-952-4998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MINH LUU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 708-680-2515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------