MEDICARE: DR. MAHER AL-KOUBAYTARI M.D.

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	036094781	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	:	1437124419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHER AL-KOUBAYTARI M.D.

Provider Business Mailing Address
First Line	:	5025 N PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2772
Country	:	US
Telephone Number	:	773-931-8082
Fax Number	:	888-847-9526

Provider Business Practice Location Address
First Line	:	5025 N PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2772
Country	:	US
Telephone Number	:	773-931-8082
Fax Number	:	888-847-9526

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	01/30/2018

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