MEDICARE: DR. MAMDOUH LATIF ISHAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036041272	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275612343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAMDOUH LATIF ISHAK MD

Provider Business Mailing Address
First Line	:	121 S WILKE ROAD
Second Line	:	SUITE 110
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1524
Country	:	US
Telephone Number	:	847-398-4536
Fax Number	:	847-398-4712

Provider Business Practice Location Address
First Line	:	121 S WILKE ROAD
Second Line	:	SUITE 110
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1524
Country	:	US
Telephone Number	:	847-398-4536
Fax Number	:	847-398-4712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	12/09/2011

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