Provider Demographics
NPI:1093876492
Name:HACHACHE, AMAL (MD)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:HACHACHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 EAST RANDOLPH STREET
Mailing Address - Street 2:904
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5069
Mailing Address - Country:US
Mailing Address - Phone:312-296-8307
Mailing Address - Fax:
Practice Address - Street 1:2875 W 19TH STREET
Practice Address - Street 2:ST ANTHONY HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-484-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X, 2084N0600X, 2084P0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Not Answered2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601019OtherBC
IL31601019OtherBC
914970Medicare ID - Type Unspecified