Provider Demographics
NPI:1386881688
Name:ALSHOBAKI, MANSOUR MOH'D (MD)
Entity type:Individual
Prefix:DR
First Name:MANSOUR
Middle Name:MOH'D
Last Name:ALSHOBAKI
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 1:8014 KIRKCALDY CT
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2768
Mailing Address - Country:US
Mailing Address - Phone:219-512-5533
Mailing Address - Fax:708-424-9901
Practice Address - Street 1:7350 W COLLEGE DR STE 201
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1190
Practice Address - Country:US
Practice Address - Phone:708-424-9900
Practice Address - Fax:708-424-9901
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069154A207Q00000X
IL125.053832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125844Medicaid