Dr. Mamdouh H Hassaballa
General Practice Physician
1105 Milwaukee Ave
Riverwoods
, Illinois 60015-3512
Dr. Mamdouh H Hassaballa
General Practice Physician
1105 Milwaukee Ave
Riverwoods
, Illinois 60015-3512
(847) 325-5114
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About
Features
Specialties
- General Practice Physician
Languages spoken
- English
Location
First Address
- Dr. Mamdouh H Hassaballa
- 1105 Milwaukee Ave
- Riverwoods, IL
- Zip : 60015-3512
- Fax : (847) 325-5114
- Phone : (847) 325-5110
Second Address
- Dr. Mamdouh H Hassaballa
- 1105 Milwaukee Ave
- Riverwoods, IL
- Zip : 60015-3512
- Fax : (847) 325-5114
- Phone : (847) 325-5110
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208D00000X | General Practice Physician | 036069096 | IL |
National Provider Identifier
| NPI | 1003815069 |
|---|---|
| Provider Name | Dr. Mamdouh H Hassaballa |
| First Address | Riverwoods, IL 60015-3512 |
| Second Address | Riverwoods, IL 60015-3512 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/07/2005 |
| Last Update Date | 16/12/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036069096 | (05) | IL |
| C46226 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.