Provider Demographics
NPI:1144379272
Name:MAYSOON AL NAQEEB MD SC
Entity Type:Organization
Organization Name:MAYSOON AL NAQEEB MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAYSOON
Authorized Official - Middle Name:
Authorized Official - Last Name:AL NAQEEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-288-4411
Mailing Address - Street 1:1525 EAST 53RD STREET
Mailing Address - Street 2:SUITE 716
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615
Mailing Address - Country:US
Mailing Address - Phone:773-288-4411
Mailing Address - Fax:773-288-2797
Practice Address - Street 1:12255 SOUTH 80TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PATOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-7800
Practice Address - Fax:708-923-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03645104Medicaid
IL03645104Medicaid
D12952Medicare UPIN