Healthcare Provider Details

I. General information

NPI: 1902252331
Provider Name (Legal Business Name): LAMIS EL KABAB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE STE 1700
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE STE 1700
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 780-216-6906
  • Fax: 708-216-5858
Mailing address:
  • Phone:
  • Fax: 708-216-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036.176596
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP103443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: