Provider Demographics
NPI:1013051705
Name:MAATOUK, ISSAM MOUSSA (MD)
Entity type:Individual
Prefix:DR
First Name:ISSAM
Middle Name:MOUSSA
Last Name:MAATOUK
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 1:3926 W TOUHY AVE
Mailing Address - Street 2:# 372
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1028
Mailing Address - Country:US
Mailing Address - Phone:847-810-9095
Mailing Address - Fax:
Practice Address - Street 1:7301 N LINCOLN AVE STE 183
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1736
Practice Address - Country:US
Practice Address - Phone:224-766-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041801A207R00000X
IL036-086819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine