Provider Demographics
NPI:1154563914
Name:TRABOLSI, MAIS (MD)
Entity type:Individual
Prefix:
First Name:MAIS
Middle Name:
Last Name:TRABOLSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1607
Mailing Address - Country:US
Mailing Address - Phone:331-221-2900
Mailing Address - Fax:331-221-2733
Practice Address - Street 1:755 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1607
Practice Address - Country:US
Practice Address - Phone:331-221-2900
Practice Address - Fax:331-221-2733
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine