Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 036140283 | IL |
NPI | 1740598523 |
---|---|
Provider Name | Osama Anwar Ahmed Raslan |
First Address | Brookfield, IL 60513-1414 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 21/07/2016 |