Provider Demographics
NPI:1255479705
Name:SALEH OBAISI MD LTD
Entity Type:Organization
Organization Name:SALEH OBAISI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-935-3342
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-0347
Mailing Address - Country:US
Mailing Address - Phone:217-935-3342
Mailing Address - Fax:217-935-5351
Practice Address - Street 1:505 W SIDE SQ
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-1661
Practice Address - Country:US
Practice Address - Phone:217-935-3342
Practice Address - Fax:217-935-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211778Medicare ID - Type Unspecified