Provider Demographics
NPI:1326299611
Name:MAZHARI, ALALEH (DO)
Entity Type:Individual
Prefix:DR
First Name:ALALEH
Middle Name:
Last Name:MAZHARI
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER BLDG 54 DEPT ENDOCRINE
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-6015
Mailing Address - Fax:708-216-5936
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER BLDG 54 DEPT ENDOCRINE
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-6015
Practice Address - Fax:708-216-5936
Is Sole Proprietor?:No
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036117803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine