Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 36101786 | IL |
NPI | 1083640361 |
---|---|
Provider Name | Dr. Oussama Itani |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 03/06/2016 |