Provider Demographics
NPI:1750769006
Name:IYAD M ALKHOURI MD
Entity type:Organization
Organization Name:IYAD M ALKHOURI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-846-1644
Mailing Address - Street 1:333 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3901
Mailing Address - Country:US
Mailing Address - Phone:630-846-1644
Mailing Address - Fax:847-440-2641
Practice Address - Street 1:333 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3901
Practice Address - Country:US
Practice Address - Phone:630-846-1644
Practice Address - Fax:847-440-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2084P0800X261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH66216Medicare UPIN
ILIL6695Medicare PIN