Basic Information
| Provider Information | |||||||||
| NPI: | 1952303323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASR | ||||||||
| FirstName: | ISAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1449 W FLETCHER ST | ||||||||
| Address2: | #3 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606572112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739294728 | ||||||||
| FaxNumber: | 3128649656 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 W LAKE ST | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601604039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086813000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036077687 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.