Provider Demographics
NPI:1073738340
Name:ALIKHAN NADIRA MD
Entity Type:Organization
Organization Name:ALIKHAN NADIRA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-447-6970
Mailing Address - Street 1:348 EVELYN RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1736
Mailing Address - Country:US
Mailing Address - Phone:773-265-2179
Mailing Address - Fax:630-620-0794
Practice Address - Street 1:348 EVELYN RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1736
Practice Address - Country:US
Practice Address - Phone:773-265-2179
Practice Address - Fax:630-620-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603760OtherBLUE SHIELD
IL036065774Medicaid
IL31603760OtherBLUE SHIELD
IL31603760OtherBLUE SHIELD
ILE54895Medicare UPIN