Provider Demographics
NPI:1225076953
Name:BRODECH, ALLA (MD)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:BRODECH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:SHCHEGELSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9933 LAWLER AVE
Mailing Address - Street 2:STE 520
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-763-1775
Mailing Address - Fax:847-763-7375
Practice Address - Street 1:9933 LAWLER AVE STE 520
Practice Address - Street 2:STE 520
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3724
Practice Address - Country:US
Practice Address - Phone:847-763-1775
Practice Address - Fax:847-763-7375
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095541Medicaid
IL438970Medicare ID - Type Unspecified
IL036095541Medicaid