Provider Demographics
NPI:1316169949
Name:ALEXIAN BROTHERS MEDICAL CENTER
Entity type:Organization
Organization Name:ALEXIAN BROTHERS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:ISAAKOVICH
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-644-6778
Mailing Address - Street 1:800 BIESTERFIELD RD STE 605
Mailing Address - Street 2:EBERLE MEDICAL OFFICE BUILDING
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3362
Mailing Address - Country:US
Mailing Address - Phone:718-644-6778
Mailing Address - Fax:847-364-6720
Practice Address - Street 1:800 BIESTERFIELD RD STE 605
Practice Address - Street 2:EBERLE MEDICAL OFFICE BUILDING
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3362
Practice Address - Country:US
Practice Address - Phone:718-644-6778
Practice Address - Fax:847-364-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243397275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit