Provider Demographics
NPI:1720115991
Name:AL-SAMARRAI, LAHAB HASSAN
Entity Type:Individual
Prefix:MR
First Name:LAHAB
Middle Name:HASSAN
Last Name:AL-SAMARRAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 OAKTON ST
Mailing Address - Street 2:APARTMENT #1F
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2875
Mailing Address - Country:US
Mailing Address - Phone:312-343-1967
Mailing Address - Fax:847-864-9118
Practice Address - Street 1:307 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1008
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5311
Practice Address - Country:US
Practice Address - Phone:312-343-1967
Practice Address - Fax:847-864-9118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635057Medicare UPIN