Provider Demographics
NPI:1326178302
Name:NADOUR, ALAN M (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:NADOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALAA
Other - Middle Name:
Other - Last Name:NADOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1069
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:232 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6893
Practice Address - Country:US
Practice Address - Phone:919-859-1276
Practice Address - Fax:919-851-4519
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126312174400000X, 207RC0000X
NC201202254202K00000X, 207R00000X, 207RC0000X
SC31392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036126312Medicaid
SC313921Medicaid
SC313921Medicaid
SCAA37483640Medicare PIN
SCAA37487951Medicare PIN