Provider Demographics
NPI:1437556024
Name:ALMANSOORI, KHALED (MD, MED, MBBCH)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:
Last Name:ALMANSOORI
Suffix:
Gender:M
Credentials:MD, MED, MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2549
Mailing Address - Country:US
Mailing Address - Phone:929-442-3181
Mailing Address - Fax:
Practice Address - Street 1:6701 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2105
Practice Address - Country:US
Practice Address - Phone:708-599-5000
Practice Address - Fax:708-599-0801
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD042563207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD042563OtherWASHINGTON DC MEDICAL LICENSE NUMBER
DCW14092132COtherWASHINGTON DRUG REGISTRATION CONTROL NUMBER
IL036150671OtherIL MEDICAL LICENSE NUMBER
NY292542OtherNY MEDICAL LICENSE NUMBER
IL036150671OtherIL MEDICAL LICENSE NUMBER
NY292542OtherNY MEDICAL LICENSE NUMBER