Provider Demographics
NPI:1336111285
Name:ALZEIN, BASHAR M (MD)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:M
Last Name:ALZEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12533 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1071
Mailing Address - Country:US
Mailing Address - Phone:708-425-4571
Mailing Address - Fax:708-428-4542
Practice Address - Street 1:15030 S RAVINIA AVE
Practice Address - Street 2:SUITE 38
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3256
Practice Address - Country:US
Practice Address - Phone:708-428-4571
Practice Address - Fax:708-428-4542
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201005230Medicaid
IL212882Medicare ID - Type Unspecified
IN201005230Medicaid
ILI07727Medicare UPIN