Provider Demographics
NPI:1316256688
Name:DIAB, SHERIF
Entity type:Individual
Prefix:
First Name:SHERIF
Middle Name:
Last Name:DIAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10849 LENTFER CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5609
Mailing Address - Country:US
Mailing Address - Phone:773-676-7298
Mailing Address - Fax:708-286-6461
Practice Address - Street 1:10849 LENTFER CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5609
Practice Address - Country:US
Practice Address - Phone:708-323-7608
Practice Address - Fax:708-286-6461
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070015644OtherIL LICENSE NUMBER