Provider Demographics
NPI:1790928893
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:
Authorized Official - First Name:M . MUFFADDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-957-2100
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-957-2100
Mailing Address - Fax:708-957-8044
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-957-2100
Practice Address - Fax:708-957-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6262110001Medicare NSC