Provider Demographics
NPI:1255340048
Name:VAN AALST, JOHN J
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:VAN AALST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1318
Mailing Address - Country:US
Mailing Address - Phone:708-848-0396
Mailing Address - Fax:
Practice Address - Street 1:966 W. 21 STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-254-1400
Practice Address - Fax:312-829-6829
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03655172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics