Provider Demographics
NPI:1467741314
Name:ALPHA MED PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:ALPHA MED PHYSICIANS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBRAMANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-342-1900
Mailing Address - Street 1:17333 S LAGRANGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7581
Mailing Address - Country:US
Mailing Address - Phone:708-342-1900
Mailing Address - Fax:708-745-9993
Practice Address - Street 1:17333 S LAGRANGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7581
Practice Address - Country:US
Practice Address - Phone:708-342-1900
Practice Address - Fax:708-745-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6262110004Medicare NSC
ILIL1646Medicare PIN