Basic Information
| Provider Information | |||||||||
| NPI: | 1740642065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AL MOMANI | ||||||||
| FirstName: | LAITH | ||||||||
| MiddleName: | ADEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 259 E ERIE ST STE 1600 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126955620 | ||||||||
| FaxNumber: | 3126957095 | ||||||||
| Practice Location | |||||||||
| Address1: | 259 E ERIE ST STE 1600 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126955620 | ||||||||
| FaxNumber: | 3126957095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 036159796 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.