=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780069732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARIM ELALFY MPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2015
-----------------------------------------------------
Last Update Date | 07/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6060 W 95TH ST
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-2778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-952-1052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10619 GABRIELLE LN
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-418-3548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070020625
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------