Individual
IBRAHIM NAIM MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5 KISH HOSPITAL DR STE 103, DEKALB, IL 60115-9602
(630) 232-0280
(630) 232-3895
Mailing address
5 KISH HOSPITAL DR STE 103, DEKALB, IL 60115-9602
(630) 232-0280
(630) 232-3895
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-116574
IL
207Q00000X
Family Medicine Physician
036116574
IL
207R00000X
Internal Medicine Physician
4301095391
MI
207RC0000X
Cardiovascular Disease Physician
036116574
IL
207RI0011X
Interventional Cardiology Physician
01064591A
IN
207RI0011X
Interventional Cardiology Physician
Primary
036116574
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036116574
—
IL
01
—
3932056
BLUE SHIELD
IL
Enumeration date
09/22/2006
Last updated
05/20/2025
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