Provider Demographics
NPI:1710701701
Name:CENTRAL ILLINOIS RHEUMATOLOGY PLLC
Entity type:Organization
Organization Name:CENTRAL ILLINOIS RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANI
Authorized Official - Middle Name:
Authorized Official - Last Name:HABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-552-7404
Mailing Address - Street 1:11003 N TUSCANY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-7518
Mailing Address - Country:US
Mailing Address - Phone:562-552-7404
Mailing Address - Fax:
Practice Address - Street 1:11003 N TUSCANY RIDGE CT
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IL
Practice Address - Zip Code:61525-7518
Practice Address - Country:US
Practice Address - Phone:562-552-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty