Provider Demographics
NPI:1841299591
Name:AL-MASRI, HYTHAM (MD)
Entity type:Individual
Prefix:DR
First Name:HYTHAM
Middle Name:
Last Name:AL-MASRI
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 1:8150 185TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-9319
Mailing Address - Country:US
Mailing Address - Phone:708-444-0444
Mailing Address - Fax:
Practice Address - Street 1:8150 185TH ST STE A60487
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9229
Practice Address - Country:US
Practice Address - Phone:708-444-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109631207ZP0105X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-109631-1Medicaid
IL036-109631-1Medicaid
IL357801/K11306Medicare ID - Type Unspecified