Basic Information
| Provider Information | |||||||||
| NPI: | 1740217686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALIBA | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1542 S BLOOMINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653017449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036108589 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01064809A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01824550 | 01 | IN | RR PTAN | OTHER | 371391171002 | 05 | IL | MEDICAID | 036108589 | 01 | IL | ILLINOIS LICENSE | OTHER | 371391171006 | 05 | IL | MEDICAID | P00480255 | 01 | IL | RAILROAD MEDICARE PTAN | OTHER | 03300006 | 01 | IL | ILLINOIS HEALTH CONNECT-EFFINGHAM | OTHER | 337651 | 01 | PERSONAL CARE | OTHER | 617396 | 01 | IL | HEALTHLINK | OTHER | 617396 | 01 | IL | HEALTHLINK # | OTHER | 04800010 | 01 | IL | ILLINOIS HEALTH CONNECT-NEWTON | OTHER | 200902360 | 05 | IN | MEDICAID | BS8331554 | 01 | IL | DEA | OTHER | 336073507 | 01 | IL | ILLINOIS CONTROLLED SUBSTANCE LICENSE | OTHER | CG5365 | 01 | IL | RAILROAD MEDICARE GROUP | OTHER | 2523247 | 01 | IL | BC/BS# | OTHER | 036108589 | 05 | IL | MEDICAID |