Provider Demographics
NPI:1215937636
Name:OTHMAN, EYAS O (MD)
Entity type:Individual
Prefix:DR
First Name:EYAS
Middle Name:O
Last Name:OTHMAN
Suffix:
Gender:M
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:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4119
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-333-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108069207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108069Medicaid
ILK47252Medicare PIN
ILK13393Medicare PIN
ILK13394Medicare PIN
ILH78141Medicare UPIN
IL036108069Medicaid
IL040017817Medicare PIN
IL231199Medicare PIN
ILP00281940Medicare PIN
ILK21623Medicare PIN
ILP00221949Medicare PIN
IL040017816Medicare PIN