Basic Information
Provider Information | |||||||||
NPI: | 1659529196 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHAABAN | ||||||||
FirstName: | HADI | ||||||||
MiddleName: | FAROUK | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 29373 NETWORK PL | ||||||||
Address2: |   | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606731293 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8473905900 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 801 S MILWAUKEE AVE | ||||||||
Address2: |   | ||||||||
City: | LIBERTYVILLE | ||||||||
State: | IL | ||||||||
PostalCode: | 600483204 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8479813660 | ||||||||
FaxNumber: | 8479565108 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/08/2008 | ||||||||
LastUpdateDate: | 06/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 82781 | GA | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 123456789 | MI | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 02004925A | IN | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0102X | 82781 | GA | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 63992-21 | WI | N |   | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | 036-123232 | IL | Y |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.