Provider Demographics
NPI:1174558282
Name:AL-NAQEEB, MAYSOON (MD)
Entity type:Individual
Prefix:
First Name:MAYSOON
Middle Name:
Last Name:AL-NAQEEB
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-0369
Mailing Address - Country:US
Mailing Address - Phone:815-463-0098
Mailing Address - Fax:815-462-4955
Practice Address - Street 1:12255 S 80TH AVE
Practice Address - Street 2:STE 201
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1270
Practice Address - Country:US
Practice Address - Phone:708-923-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045134207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK31752OtherPTAN
IL363098432Medicaid
ILK31752OtherPTAN
IL363098432Medicaid