Individual
LARA ALKHAWALDEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1621 N SAYRE AVE, CHICAGO, IL 60707-4322
(708) 543-4519
Mailing address
1621 N SAYRE AVE, CHICAGO, IL 60707-4322
(708) 543-4519
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01079976A
IN
208M00000X
Hospitalist Physician
01079976A
IN
208M00000X
Hospitalist Physician
Primary
036144150
IL
390200000X
Student in an Organized Health Care Education/Training Program
125067573
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021101
—
IN
Enumeration date
05/04/2015
Last updated
06/07/2024
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