Basic Information
| Provider Information | |||||||||
| NPI: | 1649271123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALSIKAFI | ||||||||
| FirstName: | NEJD | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 S GREENLEAF ST | ||||||||
| Address2: | SUITE J | ||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9475991111 | ||||||||
| FaxNumber: | 8475991148 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 S GREENLEAF ST | ||||||||
| Address2: | SUITE J | ||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9475991111 | ||||||||
| FaxNumber: | 8475991148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 036-102027 | IL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 036-102027-1 | 05 | IL | MEDICAID |