Provider Demographics
NPI:1144253212
Name:CHELLI, HEPHZIBAH ESTHER (MD)
Entity type:Individual
Prefix:
First Name:HEPHZIBAH
Middle Name:ESTHER
Last Name:CHELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3500
Mailing Address - Country:US
Mailing Address - Phone:319-274-1000
Mailing Address - Fax:319-292-6526
Practice Address - Street 1:555 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-764-9675
Practice Address - Fax:309-764-3106
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7957207Q00000X
IA37950207Q00000X
NC2021-02236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1144253212Medicaid
IAR7957OtherLICENSE NUMBER
IA1144253212Medicaid
IA719260112Medicare PIN