MEDICARE: LARA ALKHAWALDEH M.D

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	207Q00000X	Family Medicine Physician	01079976A	IN
2	208M00000X	Hospitalist Physician	01079976A	IN
3	390200000X	Student in an Organized Health Care Education/Training Program	125067573	IL
4	208M00000X	Hospitalist Physician	036144150	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982081543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA ALKHAWALDEH M.D

Provider Business Mailing Address
First Line	:	1621 N SAYRE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4322
Country	:	US
Telephone Number	:	708-543-4519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 N SAYRE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4322
Country	:	US
Telephone Number	:	708-543-4519
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	06/07/2024

Similar Medicare Providers

1649826470 — DANNY JACOB KANIYALY PT, DPT
Practice Location Address:

1923 N WESTERN AVE
CHICAGO, IL
60647-4322

Practice Phone: 773-492-3880
Practice Fax: 773-492-3881

1598853541 — MS. ROSALIE DEVONSHIRE MSW, LCSW
Practice Location Address:

4322 N ELSTON AVE
CHICAGO, IL
60641-2144

Practice Phone: 773-604-5321
Practice Fax: 773-604-5231

1477694305 — KRISTIN DRYDEN DPT
Practice Location Address:

1923 N WESTERN AVE
CHICAGO, IL
60647-4322

Practice Phone: 773-492-3880
Practice Fax: 773-492-3881

1447587936 — MS. PRISCILLA MURPHY KANG LCSW
Practice Location Address:

1 N DEARBORN ST FL 10
CHICAGO, IL
60602-4322

Practice Phone: 312-986-4158
Practice Fax: 312-986-4187

1063957892 — JENNY COOK MT-BC
Practice Location Address:

4819 W ROSCOE ST , APT 2N
CHICAGO, IL
60641-4322

Practice Phone: 231-301-0407
Practice Fax:

1285167577 — PROJECT VIDA, INC.
Practice Location Address:

2659 S KEDVALE AVE
CHICAGO, IL
60623-4322

Practice Phone: 773-277-2291
Practice Fax:

Directions to “ LARA ALKHAWALDEH M.D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.