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General NPI Number Information
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NPI Number | 1750769006
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Entity Type | Organization
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Legal Business Name | IYAD M ALKHOURI MD
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60601-3901
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Country | US
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Telephone | 630-846-1644
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Fax | 847-440-2641
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Provider Business Mailing Address
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Address Line | 333 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60601-3901
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Country | US
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Telephone | 630-846-1644
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Fax | 847-440-2641
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Authorized Official
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Title or Position | BILLING/CREDENTIALING MANAGER
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Name | MISS PAMI CHOWDHARY
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Credential |
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Telephone | 630-846-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 2084P0800X
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License Number State | MI
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