Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35530 | IA |
N | 2084N0400X | Neurologist | 35.096508 | OH |
Y | 2084N0402X | Child Neurologist | 036141882 | IL |
NPI | 1144203753 |
---|---|
Provider Name | Haidar Kabbani |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0444802 | (05) | IA |