Individual
ALIYAH MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-6949
(708) 684-2675
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-008132
IL
363A00000X
Physician Assistant
C0007891
MD
Other
Enumeration date
03/16/2021
Last updated
02/20/2026
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