Provider Demographics
NPI:1467140145
Name:ALZANDANI, SADDIQ
Entity Type:Individual
Prefix:
First Name:SADDIQ
Middle Name:
Last Name:ALZANDANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 S HARLEM AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1598
Mailing Address - Country:US
Mailing Address - Phone:708-671-1685
Mailing Address - Fax:708-671-1695
Practice Address - Street 1:12508 S HARLEM AVE STE C
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1598
Practice Address - Country:US
Practice Address - Phone:708-671-1685
Practice Address - Fax:708-671-1695
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine