Provider Demographics
NPI:1902841521
Name:MAKHLOUF, MANSOUR VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:MANSOUR
Middle Name:VINCENT
Last Name:MAKHLOUF
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 1:9301 GOLF RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:847-297-8001
Mailing Address - Fax:847-297-8125
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:847-297-8001
Practice Address - Fax:847-297-8125
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360647602082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD32601Medicare UPIN
IL771550Medicare PIN