1265418982 NPI number — DR. ADEL SAMY RAHEB M.D.

Table of content: DR. ADEL SAMY RAHEB M.D. (NPI 1265418982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265418982 NPI number — DR. ADEL SAMY RAHEB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHEB
Provider First Name:
ADEL
Provider Middle Name:
SAMY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANNA
Provider Other First Name:
ADEL
Provider Other Middle Name:
SAMY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265418982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMPAIGN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61820-3981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-366-1255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W UNIVERSITY AVE STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMPAIGN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61820-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-366-1255
Provider Business Practice Location Address Fax Number:
217-429-0108
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  036110172 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036110172 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05832038 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DE3439 . This is a "RAILROAD MEDICARE GROUP PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 634112 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00286821 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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