Provider Demographics
NPI:1841932357
Name:HAJEISSA, ALAA (MD)
Entity type:Individual
Prefix:
First Name:ALAA
Middle Name:
Last Name:HAJEISSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 S SACRAMENTO AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3462
Mailing Address - Country:US
Mailing Address - Phone:734-604-3618
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST STE 720
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5027
Practice Address - Country:US
Practice Address - Phone:734-604-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program