Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 036064760 | IL |
NPI | 1902841521 |
---|---|
Provider Name | Mansour Vincent Makhlouf |
First Address | Des Plaines, IL 60016-1667 |
Second Address | Des Plaines, IL 60016-1667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 07/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D32601 | (02) | IL |