Provider Demographics
NPI:1639854888
Name:ELMANSOURI, SABRI
Entity Type:Individual
Prefix:
First Name:SABRI
Middle Name:
Last Name:ELMANSOURI
Suffix:
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 1:9433 S 79TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2195
Mailing Address - Country:US
Mailing Address - Phone:312-647-4119
Mailing Address - Fax:
Practice Address - Street 1:9433 S 79TH AVE APT 104
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2195
Practice Address - Country:US
Practice Address - Phone:312-647-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program