Provider Demographics
NPI:1417033705
Name:HAQUE ALI, SABEEHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SABEEHA
Middle Name:
Last Name:HAQUE ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SABEEHA
Other - Middle Name:
Other - Last Name:HAQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:102 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-8513
Mailing Address - Country:US
Mailing Address - Phone:217-442-5863
Mailing Address - Fax:217-442-5040
Practice Address - Street 1:102 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-8513
Practice Address - Country:US
Practice Address - Phone:217-442-5863
Practice Address - Fax:217-442-5040
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL463483975001Medicaid