Provider Demographics
NPI:1518272384
Name:KIROLLOS, MARIAM ALBER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:ALBER
Last Name:KIROLLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3033 OGDEN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1976
Mailing Address - Country:US
Mailing Address - Phone:331-702-2455
Mailing Address - Fax:331-229-8191
Practice Address - Street 1:3033 OGDEN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1976
Practice Address - Country:US
Practice Address - Phone:331-702-2455
Practice Address - Fax:331-229-8191
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2024-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036133480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMAK727Medicare UPIN