Basic Information
| Provider Information | |||||||||
| NPI: | 1467448456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALZAHABI | ||||||||
| FirstName: | BASHAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W TEMPLE AVE | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159642772 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 W TEMPLE AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159642772 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036093669 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RN0300X | 036093669 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 371322240 | 01 | IL | TAX ID | OTHER | 371322240001 | 05 | IL | MEDICAID |