Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036144636 | IL |
Y | 207RC0000X | Internist - Cardiovascular Disease | 036144636 | IL |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 036144636 | IL |
NPI | 1043537871 |
---|---|
Provider Name | Dr. Mohamed Rafa Labedi |
First Address | Springfield, IL 62794-9627 |
Second Address | Springfield, IL 62702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036144636 | (05) | IL |