Provider Demographics
NPI:1427041243
Name:HABBAL, BASSAM (MD,FACC,FCCP)
Entity Type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:
Last Name:HABBAL
Suffix:
Gender:M
Credentials:MD,FACC,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 S CICERO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6459
Mailing Address - Country:US
Mailing Address - Phone:708-636-7575
Mailing Address - Fax:708-636-6193
Practice Address - Street 1:10837 S CICERO AVE STE 200
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6459
Practice Address - Country:US
Practice Address - Phone:708-636-7575
Practice Address - Fax:708-636-6193
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-072518207RC0000X, 207RC0001X
IL036072518207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072518Medicaid
IL21622931OtherBCBS GROUP #
IL036072518Medicaid
IL060053889Medicare ID - Type UnspecifiedRAILROAD INDIV PROV #
ILE19255Medicare UPIN
IL21622931OtherBCBS GROUP #
ILCI8250Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
IL388180Medicare ID - Type UnspecifiedANOTHER MEDICARE GROUP #