Provider Demographics
NPI:1700951597
Name:YAMOUT, NABIL AREF (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:AREF
Last Name:YAMOUT
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 1:222 COLORADO AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1334
Mailing Address - Country:US
Mailing Address - Phone:815-469-2123
Mailing Address - Fax:815-469-2149
Practice Address - Street 1:222 COLORADO AVENUE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1334
Practice Address - Country:US
Practice Address - Phone:815-469-2123
Practice Address - Fax:815-469-2149
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09915014OtherBLUE CROSS BLUE SHIELD
C40998Medicare UPIN
P05200Medicare PIN
649420Medicare ID - Type UnspecifiedPROV #