Basic Information
| Provider Information | |||||||||
| NPI: | 1881603132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELSHERBINI | ||||||||
| FirstName: | MEDHAT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2401 W MAIN ST | ||||||||
| Address2: | VETERANS AFFAIR MEDICAL CENTER | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629591188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975311 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 W MAIN ST | ||||||||
| Address2: | VETERANS AFFAIR MEDICAL CENTER | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629591188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975311 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-116181 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 036-116181 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | P00356270 | 01 | IL | RR MEDICARE | OTHER | 036116181 | 01 | IL | BCBS OF IL | OTHER |