MEDICARE: LUJAIN TALIB ALJUDAIBI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0207X	Pediatric Hematology & Oncology Physician	125.085054	IL

General Provider Information

NPI Number	:	1023838257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUJAIN TALIB ALJUDAIBI MD

Provider Business Mailing Address
First Line	:	175 N HARBOR DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7344
Country	:	US
Telephone Number	:	847-924-0846
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 N HARBOR DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7344
Country	:	US
Telephone Number	:	847-924-0846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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