Basic Information
| Provider Information | |||||||||
| NPI: | 1326178302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NADOUR | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NADOUR | ||||||||
| OtherFirstName: | ALAA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2001 BUTTERFIELD RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252730 | ||||||||
| FaxNumber: | 8442055691 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 CROSSROADS BLVD | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275186893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198591276 | ||||||||
| FaxNumber: | 9198514519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 036126312 | IL | N | Other Service Providers | Specialist | 202K00000X | 201202254 | NC | N | Allopathic & Osteopathic Physicians | Phlebology | 207R00000X | 201202254 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 31392 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 036126312 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 201202254 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 036126312 | 05 | IL | MEDICAID | 313921 | 05 | SC | MEDICAID |