Provider Demographics
NPI:1225241979
Name:JABIR, BUTHAINA M (MD)
Entity Type:Individual
Prefix:
First Name:BUTHAINA
Middle Name:M
Last Name:JABIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 95TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5041
Mailing Address - Country:US
Mailing Address - Phone:630-856-8670
Mailing Address - Fax:630-548-3421
Practice Address - Street 1:1012 95TH ST STE 3
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5040
Practice Address - Country:US
Practice Address - Phone:630-856-8670
Practice Address - Fax:630-548-3421
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114517207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
400280OtherMEDICARE PTAN
IL036114517Medicaid
I45366Medicare UPIN