Individual
DR. HAYTHAM MANSOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
19255 EVERETT LN, SUITE B, MOKENA, IL 60448
(630) 656-3171
(630) 657-0131
Mailing address
PO BOX 711, LOMBARD, IL 60148-0711
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005301
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
07001118A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00920915
RAILROAD MEDICARE
IN
Enumeration date
10/18/2006
Last updated
01/10/2020
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