Mamdouh Latif Ishak, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036041272 Issued in IL

Practice address

121 S Wilke Road
Suite 110
Arlington Heights, IL 60005-1524

Phone

(847) 398-4536

Fax

(847) 398-4712

NPI assigned

Nov 2, 2006

Last updated

Dec 9, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arlington Primary Care SC

  dba Arlington Primary Care

  • Internal Medicine Physician
  • Arlington Heights, IL
  • NPI 1205084571
  Medicare reassignment NPD Authorized official
• Suburban Primary Care

  • Internal Medicine Physician
  • Arlington Heights, IL
  • NPI 1114104783
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1275612343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S WILKE ROAD",
            "address_2": "SUITE 110",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600051524",
            "telephone_number": "847-398-4536",
            "fax_number": "847-398-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S WILKE ROAD",
            "address_2": "SUITE 110",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600051524",
            "telephone_number": "847-398-4536",
            "fax_number": "847-398-4712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHAK",
        "first_name": "MAMDOUH",
        "middle_name": "LATIF",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036041272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036041272",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Irvin, LMFT
• Daniel Jude Irving, M.D.
• Isd Renal Inc (Arlington Heights Renal Center)
• Isd Schaumburg LLC
• Rebekah Isgitt
• Maria Caunca Israel, M.D.
• Kerry F Ito, MA, LCPC
• Aurelian S. Ivan, M.D.
• Madalina Ivan, DDS
• Kelsey Iversen, MS OTR/L

• Internal Medicine Physician in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.