Healthcare Provider Details

I. General information

NPI: 1205609229
Provider Name (Legal Business Name): SERAPHIN BAMOUNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27401 W HIGHWAY 22 STE 125
BARRINGTON IL
60010-5934
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-3088
  • Fax: 847-381-0811
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.028850
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: