Provider Demographics
NPI:1356772834
Name:HAMDARD HEALTH ALLIANCE
Entity type:Organization
Organization Name:HAMDARD HEALTH ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINISTRATION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-835-1430
Mailing Address - Street 1:228 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2889
Mailing Address - Country:US
Mailing Address - Phone:630-835-1430
Mailing Address - Fax:630-835-1433
Practice Address - Street 1:1542 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1344
Practice Address - Country:US
Practice Address - Phone:773-465-4600
Practice Address - Fax:773-465-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL781812Medicare PIN
ILIL6542Medicare UPIN