Basic Information
Provider Information | |||||||||
NPI: | 1902880321 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALAM | ||||||||
FirstName: | HASAN | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 259 E ERIE ST STE 1600 | ||||||||
Address2: |   | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606113111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3126955620 | ||||||||
FaxNumber: | 3126952729 | ||||||||
Practice Location | |||||||||
Address1: | 259 E ERIE ST STE 1600 | ||||||||
Address2: |   | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606113111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3126955620 | ||||||||
FaxNumber: | 3126952729 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/30/2005 | ||||||||
LastUpdateDate: | 10/08/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/08/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301101784 | MI | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 224253 | MA | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0102X | 4301104784 | MI | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 224253 | MA | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 036153320 | IL | Y |   | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
ID Information
ID | Type | State | Issuer | Description | J28695 | 01 | MA | BCBS OF MA | OTHER | 2102587 | 05 | MA |   | MEDICAID | 468294 | 01 | MA | TUFTS HEALTH PLAN | OTHER |