Provider Demographics
NPI:1114993979
Name:BARHOUM, MAAN (MD)
Entity Type:Individual
Prefix:
First Name:MAAN
Middle Name:
Last Name:BARHOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 186
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2905
Mailing Address - Country:US
Mailing Address - Phone:847-573-9455
Mailing Address - Fax:847-573-9456
Practice Address - Street 1:755 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 186
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2905
Practice Address - Country:US
Practice Address - Phone:847-573-9455
Practice Address - Fax:847-573-9456
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115914207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG40855Medicare UPIN
ILK30493Medicare PIN