Provider Demographics
NPI:1508386533
Name:HAQUE, SABRINA I (MD)
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:
Last Name:HAQUE
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4084 SAMOSET CIR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-4118
Mailing Address - Country:US
Mailing Address - Phone:161-835-7218
Mailing Address - Fax:
Practice Address - Street 1:5383 STATE ROUTE 154
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-3342
Practice Address - Country:US
Practice Address - Phone:618-357-2131
Practice Address - Fax:618-357-8844
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036153808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program