Healthcare Provider Details

I. General information

NPI: 1639866635
Provider Name (Legal Business Name): MANAR FAYEK-AHMED ISMAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAMSAN ISMAIL I MD

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE
CHICAGO IL
60616-2315
US

IV. Provider business mailing address

2525 S MICHIGAN AVE
CHICAGO IL
60616-2315
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-2397
  • Fax:
Mailing address:
  • Phone: 312-567-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.179646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: