Provider Demographics
NPI:1063539211
Name:GUIRGUIS, ALFRED S (DO)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:S
Last Name:GUIRGUIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W 95TH ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2199
Mailing Address - Country:US
Mailing Address - Phone:708-422-3242
Mailing Address - Fax:708-422-3243
Practice Address - Street 1:6700 W 95TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2199
Practice Address - Country:US
Practice Address - Phone:708-422-3242
Practice Address - Fax:708-422-3243
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108495207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK44986Medicare PIN