Provider Demographics
NPI:1326590720
Name:ELAMIN, MAHMOUD SR
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ELAMIN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3646
Mailing Address - Country:US
Mailing Address - Phone:708-663-6632
Mailing Address - Fax:
Practice Address - Street 1:9804 MEADE AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3646
Practice Address - Country:US
Practice Address - Phone:708-663-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70768941172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver