Provider Demographics
NPI:1326224643
Name:HUSSEIN ORELLANA LTD
Entity type:Organization
Organization Name:HUSSEIN ORELLANA LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULHAMID
Authorized Official - Middle Name:TAHA
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-955-1793
Mailing Address - Street 1:720 COLLINS ST STE B
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-1628
Mailing Address - Country:US
Mailing Address - Phone:708-955-1793
Mailing Address - Fax:
Practice Address - Street 1:720 COLLINS ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-1615
Practice Address - Country:US
Practice Address - Phone:815-582-3565
Practice Address - Fax:815-582-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-110260OtherSTATE LIC #
IL036-107501OtherSTATE LIC #