Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 036.070551 | IL |
N | 207R00000X | Internist | 036070551 | IL |
N | 111NI0900X | Internist | 036070551 | IL |
Y | 207RG0300X | Geriatric Medicine | 036.070551 | IL |
NPI | 1134362833 |
---|---|
Provider Name | Dr. Ala Jaber Albazzaz |
First Address | Lombard, IL 60148-4527 |
Second Address | Lombard, IL 60148-4527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2009 |
Last Update Date | 03/07/2014 |