Provider Demographics
NPI:1417932708
Name:ABU-HALAWA, SUBHI A (MD)
Entity Type:Individual
Prefix:
First Name:SUBHI
Middle Name:A
Last Name:ABU-HALAWA
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 1:202 10TH ST SE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2404
Mailing Address - Country:US
Mailing Address - Phone:319-364-7101
Mailing Address - Fax:319-363-1993
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:SUITE 225
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2404
Practice Address - Country:US
Practice Address - Phone:319-364-7101
Practice Address - Fax:319-363-1993
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA33358207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1417932708Medicaid
IAP00817984OtherRR MEDICARE
IAIB1598019Medicare PIN
IAIB1600019Medicare PIN
IA1417932708Medicaid