Provider Demographics
NPI:1649256512
Name:KHAMMAR, ALEXANDER JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:KHAMMAR
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 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC OPHTHALMOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-607-5280
Mailing Address - Fax:414-266-2027
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC OPHTHALMOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-607-5280
Practice Address - Fax:414-266-2027
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63552207W00000X
IL156FX1202X
IN01058559A207W00000X
IL036107142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200815870OtherMEDICARE LEGACY PROVIDER NUMBER
IN200871680BOtherMEDICAID LOCATION CHICAGO RIDGE
IL180046209OtherMEDICARE RAILROAD
IL205785OtherPTAN MEDICARE COOK COUNTY IL
ILDR4230OtherMEDICARE RAILROAD DUPAGE CO GROUP PTAN
IL036107142Medicaid
IL1083684922OtherGROUP NPI
IN200871680DOtherMEDICAID LOCATION HINSDALE
WI1649256512Medicaid
IN200871680COtherMEDICAID LOCATION ORLAND PARK
ILP00932398OtherMEDICARE RAILROAD DUPAGE CO INDIVIDUAL PTAN
IN253350OtherPTAN MEDICARE GROUP PRACTICE
IN200871680AOtherMEDICAID LOCATION MUNSTER
IL205786OtherMEDICARE DUPAGE CO GRP PTAN
IL01621679OtherBC/BS OF IL
ILP00932398OtherMEDICARE RAILROAD DUPAGE CO INDIVIDUAL PTAN
IL6180260001Medicare NSC
IL036107142Medicaid