Provider Demographics
NPI:1356731772
Name:ALAM, RIDWAN I (MD, MPH)
Entity type:Individual
Prefix:
First Name:RIDWAN
Middle Name:I
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:RIDWAN
Other - Middle Name:ALAM
Other - Last Name:ITEKUCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 E SUPERIOR ST STE 9-900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4494
Mailing Address - Country:US
Mailing Address - Phone:312-503-4748
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2915
Practice Address - Country:US
Practice Address - Phone:312-503-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-24
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.170860208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology