Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-140716 | IN |
N | 111NI0900X | Internist | 036-140716 | IN |
N | 207RC0000X | Internist - Cardiovascular Disease | 036.140716 | IL |
Y | 207RI0011X | Interventional Cardiology | 036.140716 | IL |
NPI | 1003255308 |
---|---|
Provider Name | Ehab Ghassan Dababneh |
First Address | Naperville, IL 60540-7430 |
Second Address | Naperville, IL 60540-7430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 04/10/2021 |