Provider Demographics
NPI:1861410771
Name:MOSABBEH, JAMAL (CRNA)
Entity type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:
Last Name:MOSABBEH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8409
Mailing Address - Country:US
Mailing Address - Phone:815-344-5000
Mailing Address - Fax:815-344-3347
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-344-5000
Practice Address - Fax:815-344-3347
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016788367500000X, 367500000X
NC49415367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051601Medicaid
IL214881OtherMEDICARE MULTISPECIALTY GROUP PTAN
NCP00603483OtherRAILROAD MEDICARE
NC2603865DMedicare PIN
NC2603865AMedicare PIN