Provider Demographics
NPI:1588788277
Name:ALIUDDIN, KHAJA (MD)
Entity type:Individual
Prefix:DR
First Name:KHAJA
Middle Name:
Last Name:ALIUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3307
Mailing Address - Country:US
Mailing Address - Phone:773-522-1216
Mailing Address - Fax:773-522-9660
Practice Address - Street 1:3147 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3307
Practice Address - Country:US
Practice Address - Phone:773-522-1216
Practice Address - Fax:773-522-9660
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071142Medicaid
ILC47998Medicare UPIN
IL036071142Medicaid