Provider Demographics
NPI:1386670941
Name:ALZALAM, NAZEM (MD)
Entity Type:Individual
Prefix:DR
First Name:NAZEM
Middle Name:
Last Name:ALZALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 S HARLEM AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1775
Mailing Address - Country:US
Mailing Address - Phone:708-599-8000
Mailing Address - Fax:888-383-8967
Practice Address - Street 1:8550 S HARLEM AVE STE B
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1775
Practice Address - Country:US
Practice Address - Phone:708-599-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087470Medicaid
IL036087470Medicaid