Provider Demographics
NPI:1316111693
Name:ALAA E ABDEL-MEGUID, M.D., S.C.
Entity type:Organization
Organization Name:ALAA E ABDEL-MEGUID, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAA
Authorized Official - Middle Name:EL-SAYED
Authorized Official - Last Name:ABDEL-MEGUID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-937-9300
Mailing Address - Street 1:500 N WALL ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2942
Mailing Address - Country:US
Mailing Address - Phone:815-937-9300
Mailing Address - Fax:815-929-3951
Practice Address - Street 1:500 N WALL ST
Practice Address - Street 2:SUITE 501
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2942
Practice Address - Country:US
Practice Address - Phone:815-937-9300
Practice Address - Fax:815-929-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04627231OtherBLUE CROSS BLUE SHIELD
IL04627231OtherBLUE CROSS BLUE SHIELD
ILE40755Medicare UPIN