Basic Information
| Provider Information | |||||||||
| NPI: | 1811525959 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EID | ||||||||
| FirstName: | SEIFELDIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | JAVON BEA HOSPITAL - ROCKTON AVENUE | ||||||||
| Address2: | 2400 NORTH ROCKTON AVENUE | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159715000 | ||||||||
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| Practice Location | |||||||||
| Address1: | MERCYHEALTHJAVON BEA HOSPITAL | ||||||||
| Address2: | 8201 | ||||||||
| City: | EAST RIVERSIDEBOULEVARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159715000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2020 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.