Provider Demographics
NPI:1609802495
Name:NOURBASH, SHIRENE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRENE
Middle Name:MARIE
Last Name:NOURBASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:EDWARD HINES ,JR. HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:708-202-3800
Mailing Address - Fax:708-202-7359
Practice Address - Street 1:EDWARD HINES ,JR. HOSPITAL
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-3800
Practice Address - Fax:708-202-7359
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH06508Medicare UPIN