Individual
DR. PIERROT ABI MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10837 S CICERO AVE, SUITE 200, OAK LAWN, IL 60453-6458
(708) 636-7575
(708) 636-6193
Mailing address
10837 S CICERO AVE STE 200, OAK LAWN, IL 60453-6459
(708) 636-7575
(708) 636-6193
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036-071715
IL
207RC0001X
Clinical Cardiac Electrophysiology Physician
036-071715
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036071715
—
IL
01
—
060053886
PALMETTO GBA INDIVIDUAL #
IL
01
—
21622931
BCBS GROUP #
IL
01
—
CI8250
PALMETTO GBA GROUP #
IL
Enumeration date
08/25/2005
Last updated
12/17/2021
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