Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 070007695 | IL |
N | 213ES0000X | Sports Medicine | 070007695 | IL |
Y | 225100000X | Physical Therapist | 070007695 | IL |
NPI | 1134688294 |
---|---|
Provider Name | Mr. Ashraf Ali Elkossei |
First Address | Oak Lawn, IL 60453-1938 |
Second Address | Oak Lawn, IL 60453-1938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2019 |
Last Update Date | 18/03/2019 |