Provider Demographics
NPI:1407893886
Name:ISTANBOULY, SUHAIL (MD)
Entity Type:Individual
Prefix:
First Name:SUHAIL
Middle Name:
Last Name:ISTANBOULY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S PARK AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3611
Mailing Address - Country:US
Mailing Address - Phone:618-942-7402
Mailing Address - Fax:618-942-7402
Practice Address - Street 1:217 S PARK AVE
Practice Address - Street 2:STE 1
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3611
Practice Address - Country:US
Practice Address - Phone:618-942-7402
Practice Address - Fax:618-942-7402
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098950207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098950Medicaid
ILDO2564OtherRAILROAD
ILDO2564OtherRAILROAD
ILK23183Medicare PIN
ILCF3444OtherMEDICARE RAILROAD GROUP
ILH54564Medicare UPIN
IL036098950Medicaid
ILP00270283OtherMEDICARE RAILROAD
IL370966854016Medicaid
IL141069Medicare Oscar/Certification
ILK23184Medicare PIN