Provider Demographics
NPI:1518923515
Name:NABELSI, SAMEH (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:
Last Name:NABELSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19624 GOVERNORS HWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2077
Mailing Address - Country:US
Mailing Address - Phone:708-647-9800
Mailing Address - Fax:708-647-9814
Practice Address - Street 1:19624 GOVENORS HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2038
Practice Address - Country:US
Practice Address - Phone:708-747-5850
Practice Address - Fax:708-747-9991
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31724207R00000X
IL036122835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ796815-01Medicaid
AZ796815-01Medicaid
AZH86221Medicare UPIN