Provider Demographics
NPI:1902018104
Name:ALMASRI, HUSSAM (MD)
Entity Type:Individual
Prefix:
First Name:HUSSAM
Middle Name:
Last Name:ALMASRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12632 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1428
Mailing Address - Country:US
Mailing Address - Phone:708-587-0000
Mailing Address - Fax:708-623-7628
Practice Address - Street 1:12632 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1428
Practice Address - Country:US
Practice Address - Phone:708-587-0000
Practice Address - Fax:708-623-7628
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2613OtherMEDICARE GROUP #
IL0533210001Medicare NSC
ILK47274Medicare PIN
ILI73824Medicare UPIN
IL2613002Medicare PIN
ILK38234Medicare PIN