Provider Demographics
NPI:1043237035
Name:ALKHALAF, ABDULHAMID H (MD)
Entity type:Individual
Prefix:
First Name:ABDULHAMID
Middle Name:H
Last Name:ALKHALAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 1ST ST STE 310
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3190
Mailing Address - Country:US
Mailing Address - Phone:815-285-5979
Mailing Address - Fax:815-285-5845
Practice Address - Street 1:215 E 1ST ST STE 310
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-285-5979
Practice Address - Fax:815-285-5845
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.101208207RI0200X
ND9954207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101208Medicaid
ILF400153994Medicare PIN
IL036101208Medicaid