Provider Demographics
NPI:1740087394
Name:ALAM, MARIYAM
Entity type:Individual
Prefix:
First Name:MARIYAM
Middle Name:
Last Name:ALAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 N EAST RIVER RD APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1080
Mailing Address - Country:US
Mailing Address - Phone:630-701-0137
Mailing Address - Fax:
Practice Address - Street 1:5431 N EAST RIVER RD APT 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1080
Practice Address - Country:US
Practice Address - Phone:630-701-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILSTUDENT208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery