Healthcare Provider Details

I. General information

NPI: 1134106081
Provider Name (Legal Business Name): AMAL JUBRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S FIRST AVE HINES VA, BLDG. 1
MAYWOOD IL
60153
US

IV. Provider business mailing address

2160 S FIRST AVE HINES VA, BLDG. 1
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-5402
  • Fax: 708-216-1259
Mailing address:
  • Phone: 708-216-5402
  • Fax: 708-216-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number36081555
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number36081555
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036132472
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: