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NPI Code Detail

MEDICARE: LAITH SOROUR AHMAD SOROUR

MEDICARE: LAITH SOROUR AHMAD SOROUR
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
1390200000XStudent in an Organized Health Care Education/Training Program125.082025IL

General Provider Information

NPI Number : 1861171977
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAITH SOROUR AHMAD SOROUR
Provider Business Mailing Address
First Line : 911 ELMWOOD AVE APT G3
Second Line :
City : EVANSTON
State : IL
Zip : 60202-1758
Country : US
Telephone Number : 224-529-8747
Fax Number :
Provider Business Practice Location Address
First Line : 355 RIDGE AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60202-3399
Country : US
Telephone Number : 224-529-8747
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2023
Last Update Date : 07/17/2023

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Directions to “ LAITH SOROUR AHMAD SOROUR ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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