Provider Demographics
NPI:1770526386
Name:BFDR FAMILY MEDICINE, LTD.
Entity type:Organization
Organization Name:BFDR FAMILY MEDICINE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALZEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-460-2244
Mailing Address - Street 1:12533 W LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1071
Mailing Address - Country:US
Mailing Address - Phone:708-398-3687
Mailing Address - Fax:708-428-4542
Practice Address - Street 1:10751 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1900
Practice Address - Country:US
Practice Address - Phone:708-460-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110629Medicaid
IN201005230Medicaid
IN201005230Medicaid
ILI07727Medicare UPIN