Provider Demographics
NPI:1437976784
Name:ELSHATARAT, GHASSAN
Entity type:Individual
Prefix:
First Name:GHASSAN
Middle Name:
Last Name:ELSHATARAT
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 1:10625 MAJOR AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2323
Mailing Address - Country:US
Mailing Address - Phone:224-733-9546
Mailing Address - Fax:
Practice Address - Street 1:265 NE 24TH ST STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5040
Practice Address - Country:US
Practice Address - Phone:224-733-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician