1588960132 NPI number — ALMANSUR FAMILY PRACTICE SERVICES LTD

Table of content: (NPI 1588960132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588960132 NPI number — ALMANSUR FAMILY PRACTICE SERVICES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALMANSUR FAMILY PRACTICE SERVICES LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588960132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 MIDDAUGH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARENDON HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60514-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-974-7084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7318 MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60130-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-366-1871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANSUR
Authorized Official First Name:
BAHIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
708-366-1871

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  036065718 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)