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General NPI Number Information
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NPI Number | 1366537409
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Entity Type | Individual
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Provider Name | IBRAHIM MAJZOUB M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 645 S CENTRAL AVE OUTPATIENT FACILITY
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City | CHICAGO
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State | IL
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Zip | 60644-5059
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Country | US
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Telephone | 847-800-2824
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Fax |
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Provider Business Mailing Address
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Address Line | 64 SHEFFIELD LN
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City | OAK BROOK
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State | IL
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Zip | 60523-2354
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Country | US
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Telephone | 847-298-4004
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Fax | 847-298-4006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036093658
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License Number State | IL
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