Provider Demographics
NPI:1922674134
Name:ABOU EL NASR EL BASSATNE, AYA (MD)
Entity Type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:ABOU EL NASR EL BASSATNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 W. 95TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-398-0287
Mailing Address - Fax:708-684-2032
Practice Address - Street 1:4220 W. 95TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-398-0287
Practice Address - Fax:708-684-2032
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-08-21
Deactivation Date:2022-11-25
Deactivation Code:
Reactivation Date:2023-04-26
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125077960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program