Provider Demographics
NPI:1891734257
Name:ALNATOUR, MOURAD (MD)
Entity Type:Individual
Prefix:
First Name:MOURAD
Middle Name:
Last Name:ALNATOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:309-692-6088
Mailing Address - Fax:
Practice Address - Street 1:7801 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2076
Practice Address - Country:US
Practice Address - Phone:309-692-6088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114965208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215059OtherBCBS PPO
IL7215059OtherBCBS PPO
IL809840Medicare ID - Type UnspecifiedGROUP #
ILK32872Medicare ID - Type UnspecifiedINDIVIDUAL OSF
809840004Medicare PIN