Provider Demographics
NPI:1629235767
Name:ALAN M. REICH
Entity Type:Organization
Organization Name:ALAN M. REICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1773-775-9574
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 569
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:177-377-5957
Mailing Address - Fax:177-377-5971
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 569
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:177-377-5957
Practice Address - Fax:177-377-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061772261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37758Medicare UPIN