Provider Demographics
NPI:1083640361
Name:ITANI, OUSSAMA (MD)
Entity type:Individual
Prefix:DR
First Name:OUSSAMA
Middle Name:
Last Name:ITANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:ITANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:180 HARVESTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6686
Mailing Address - Country:US
Mailing Address - Phone:773-834-8258
Mailing Address - Fax:773-834-8260
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-8258
Practice Address - Fax:773-834-8260
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361017862080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine